MEADE 


SPECIAL REGULATIONS No. 65 

UB 333 \_ 

. A5 
1918 
Copy 2 

_ ..j deal Examination for Entrance 
into the Army of the United States 
by Voluntary Enlistment or by 
Induction under the Selective 
Service Law 


1918 



WASHINGTON 

GOVERNMENT PRINTING OFFICE 
1913 

'Y&2ZL 


Monograph 







War Department, 
Washington, June 5, 1918. 

Under authority vested in him by the act of Congress of May 
Is, 1917, the President of the United States prescribes the Stand¬ 
ards of Physical Examination governing the entrance to all branches 
of the Armies of the United States, prepared under direction of the 
Surgeon General of the Army, and directs that they be published 
for the government of all concerned with the administration of said 
law, and that they be strictly observed/ The President also directs 
that they shall govern medical officers of the Regular Army, Na¬ 
tional Army,"'National ' Guard, Medical Keserve Corps, and recruit¬ 
ing officers of the United States Army in the matter of the physi¬ 
cal examination of registrants, drafted men, and applicants for 
enlistment in the Armies of the United States. 

Newton D. Baker, 

Secretary of IT 7 ar. 

........... ERRATA. 

At the end of the third jine, paragraph 103, after the word 
“service,’’ add-the-following: “except, that in the discretion of the 
Secretary of War, applicants for voluntary enlistment who have 
venereal diseases may be rejected by recruiting officers.” 

(n) 



TABLE OF CONTENTS 


OO^A 


Pa^e. 

I. Preliminary statement and rules. 1-4 

II. Order and method of examination... 4-5 

III. Eyes. 5-10 

IV. Ears. 10-13 

V. Mouth, no3e, fauce3, pharynx, larynx, trachea and e3ophagu3. 13-14 

VI. Dental requirements... 15,16 

VII. Skin. 16,17 

VIII. Head. 17,18 

IX. Spine. 18,19 

X. Scapulae. 19,20 

XI. The extremities. 20-23 

XII. Heigh', weight, and chest measurements. 24,25 

XIII. Abdomen. 25-28 

XIV. Neck. ?8-29 

XV. Genito-urinary organs and venereal disease3. 29-31 

XVI. Mental and nervous diseases. 31-35 

XVII. Lung3 and che3t wall. 35-44 

XVIII. Heart and blood vessels. 44-48 

XIX. General. 48,49 

XX. Temporary defects. 49 

XXI. Notes on malingering. 49-51 

Appendix: Important sections of the Selective Service Regulations—Rules of 
Procedure. 52-74 


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STANDARDS OF PHYSICAL EXAMINATION GOV¬ 
ERNING THE ENTRANCE TO ALL BRANCHES 
OF THE ARMIES OF THE UNITED STATES. 

FOR THE USE OF 

MEDICAL OFFICERS OF THE REGULAR ARMY, NATIONAL ARMY, 
NATIONAL GUARD, MEDICAL RESERVE CORPS, RECRUITING 
OFFICERS OF THE UNITED STATES ARMY, AND OF LOCAL 
BOARDS AND MEDICAL ADVISORY BOARDS UNDER THE SELEC¬ 
TIVE SERVICE REGULATIONS. 

I. PRELIMINARY STATEMENT AND RULES. 

1. The purpose of the Standards of Physical Examination is to 
secure greater efficiency and uniformity in the examination of regis¬ 
trants and enlisted men. Medical examiners should consider the 
standards as a guide to their discretion; therefore they are not to be 
construed too strictly or arbitrarily. The object is to procure men 
who are physically fit, or who can be made so, for the rigors of field 
service, or for special and limited service, and the determination of 
these questions is left to the judgment and discretion of the exam¬ 
ining boards, appointed under authority of the selective-service law, 
and to the military examining surgeons at mobilization camps and 
other army posts and stations. 

2. As the physical standards established by these regulations apply 
to voluntary applicants for enlistment, as well as to registrants, under 
the selective-service act, the term u registrants,” as used therein, may 
be considered as including applicants for enlistment where such in¬ 
terpretation is necessary to a proper application of the text. 

3. Voluntary applicants for enlistment who do not come within the 
standards of acceptance for general military service as applied to 
registrants under the selective-service act will be rejected for all 
military service, unless the defects are waived by authority of The 
Adjutant General of the Army. 

4. Local Boards have original jurisdiction, subject to review on 
appeal to District Boards, and may accept or reject registrants for 
military service as follows: 

(a) Registrants who on examination are found to present condi¬ 
tions which fall within the proper standards shall be unconditionally 
accepted for general military service (Group A). 

( b ) Registrants who on examination are found to suffer from 
remediable defects which fall within the proper standards may be 
accepted for general military service in the deferred remediable 
group (Group B). 


2 


( c ) Registrants who on examination are found to present defects 
which fall within the proper standards may be accepted for special 
and limited military service (Group C). 

( d) Registrants who on examination are found to present defects 
which fall within the proper standards shall be unconditionally rejected 
for all military service (Group D). 

(See sec. 128Selective Service Regulations, p. 60 herein.) 

5. Local Boards need not make complete physical examination of 
every registrant. Upon discovery of a defect requiring uncondi¬ 
tional rejection the physician of the Local Board need proceed no 
further; but in all other cases there must be a complete examination 
as prescribed in section 182, Selective Service Regulations (p. 65 
herein). 

6. Medical Advisory Boards have no power to determine finally 
whether a registrant shall be accepted or rejected for military service. 
This power is placed by the Selective Service Regulations in the Local 
and District Exemption Boards. The functions of the Medical Ad¬ 
visory Boards are, as the name imports, to examine registrants re¬ 
ferred to them by the Exemption Boards and State Adjutants Gen¬ 
eral, and to return the result of their examinations, inserted at the 
proper places in Form 1010 P.M.G.O., “Report of Physical Exam¬ 
ination ” (sec. 282, Selective Service Regulations, p. 155). The Medi¬ 
cal Advisory Boards are not required to make a complete examination 
of every registrant. At any point in the course of the examination 
when it is found that the registrant is physically or mentally unfit 
within the standards p.f unconditional rejection, the examination need 
proceed no further.. After a Medical Advisory Board has completed 
the examination of the registrant, the -chairman, or a designated 
member of the Advisory Board, shall certify the result in the proper 
space on Form 1010, and return the result in triplicate to the Local 
Board through the mail or by messenger other than the registrant. 

7. Medical Advisory Boards were created for the purpose of re¬ 
examination of registrants who request to be reexamined by a Medi¬ 
cal Advisory Board, or concerning whose physical condition the 
physicians of the Local Boards are in doubt. Local Boards should 
feel free to ask the advice of the Medical Advisory Boards concerning 
the mental and physical fitness of registrants. There should be cor¬ 
dial cooperation between the Local Boards and the Medical Advisory 
Boards. Cooperation may be made profitable and practical through 
actual consultation and conference between the Local Boards and 
Medical Advisory Boards when this is possible. In many districts the 
members of the Medical Advisory Boards have the opportunity to 
be in close touch with the Local.Boards. In some large advisory dis¬ 
tricts the opportunity for frequent consultation and conference may 
be infrequent and difficult. Through the medical aide to the gov- 


3 


ernor ways and means for cooperation may be found. The standnrd 
of efficiency of the Medical Advisory Boards should result in the re¬ 
jection of all registrants referred to the Advisory Board for exam¬ 
ination who are physically and mentally defective within the stand¬ 
ards of unconditional rejection. This is very important as a measure 
of economy and justice to the Government, the Army, and the regis¬ 
trant. 

8. Local Boards and Medical Advisory Boards should be especially 
careful in the selection of registrants who suffer from defects of 
vision, defects of hearing, and with chronic discharge from the ear 
or ears; toxic conditions associated with abnormal conditions of the 
thyroid gland; valvular disease of the heart; tuberculosis; epilepsy, 
mental disease or deficiency and irremediable defects of the feet. In 
other words, to make a good soldier the registrant must be able to see 
well, have comparatively good hearing, his heart must be able to stand 
the stress of physical exertion, he must be intelligent enough to under¬ 
stand and execute military maneuvers, obey commands, and protect 
himself, and must be able to transport himself by walking as the 
exigencies of military life may demand. 

9. District Boards have appellate jurisdiction over all decisions 
of Local Boards, including the findings of Local Boards as to 
physical qualifications; but in considering appeals as to physical 
qualifications the District Board may not conduct any new physical 
examination or receive or consider any evidence which was not con¬ 
sidered by the Local Board. (See sec. 12G, Selective Service Kegu- 
lations, p. 59 herein.) 

10. The Army medical officer detailed as medical aide to the gov¬ 
ernor should be the instrument of communication between the gov¬ 
ernor or his adjutant on the one hand and the Local and Medical 
Advisory Boards on the other hand in all matters concerning ques¬ 
tions relating to physical examinations. He should inspect the work, 
records, and methods of Local Boards and Medical Advisory Boards 
from time to time as he may be directed by the governor and give 
them all necessary instructions and assistance. 

11. Local Boards may not induct- registrants accepted for general 
military service who are in the deferred remediable group (Group B) or 
for special or limited military service (Group C), until a special call has 
been made by the Provost Marshal General’s Office for these groups of 
registrants. 

12. The final decision as to the acceptance or rejection of inducted men 
under these regulations rests with the military authorities at the mobiliza¬ 
tion camps or other military stations to which the registrants are sent upon 
induction into the military service. 

13. Instructions for the special guidance of Local and Medical 
Advisory Boards are printed in heavy type at the end of each chap* 


4 


ter and all specific directions to Local Boards and to Medical Ad¬ 
visory Boards are printed in heavy type in the text. 

14. In the appendix will be found general information and the im¬ 
portant sections of the Selective Service Regulations relating to 
physical examinations and governing medical aids and Local, Dis¬ 
trict, and Medical Advisory Boards, which will be found valuable in 
connection with the Standards of Physical Examination. 

II. ORDER AND METHOD OF EXAMINATION. 

15. The physical examination should take place in a large, w T ell- 
lighted room. A quiet communicating room should be used for the 
examination of the heart and lungs. The temperature of the room 
should be regulated in cold weather to prevent the registrant from 
becoming chilled. The registrant should be questioned about his past 
and his present physical condition. His mental characteristics and 
speech should be observed. Malingering should be borne in mind 
at all stages of the examination. 

16. No anesthetic may be given to a registrant without his volun¬ 
tary consent for the purposes of examination or to aid in the diag¬ 
nosis of defects. 

17. The following order of procedure in examining a registrant 
should be pursued, as a rule: 

{cc) Make tests of the vision. (See III, p. 5.) 

(b) Make tests of the hearing. (See IV, p. 10.) 

(<?) Examine the scalp, face, mouth, teeth, fauces, and nose. (See 
V-VI, pp. 13 and 15.) 

( d ) At this stage of the examination have the registrant take off 
all of his clothing. 

( e ) Make a thorough general inspection of the skin of the entire 
body. (See VII, p. 16.) 

(/) Observe the conformation of the back, the chest, the abdomen, 
the neck, buttocks, and the upper and lower extremities. (See XI, 
XIII, XVI, pp. 25, 29, and 30.) 

(g) Carefully observe the abdomen for the bulgings of hernia. 
(See XIII, p. 25.) 

( h ) Palpate the testicles. 

( i ) Inspect the genitals and anus while the registrant is stooping 
forward with the lower extremities separated. The registrant should 
separate the buttocks with his hands to enable the inspection of the 
anus to be made. (See XV, p. 29.) 

(j) Have the registrant vigorously exercise all of the joints of 
the upper and lower extremities, and also move the head in all direc¬ 
tions to test the mobility of the joints. (See X, pp. 20, 23, 28.) 


5 


(&) Hare the registrant bend the body forward, backward, side- 
wise, and rotate the trunk upon the pelvis, to test the mobility of the 
spine. (See VIII, IX, pp. IT, 18, 19.) 

(?) Especial attention should then be paid to the feet. (See 

XI, pp. 20, 23.) 

(m) Take the weight, the height, and the chest measurements. 
(See XII, p. 24.) 

( n ) Have the registrant put on his underdrawers, trousers, stock¬ 
ings, and shoes, then proceed to examine the chest. (See XVII, 
XVIII, pp. 35, 44.) 

III. EYES. 

18. V ision. —To determine the acuity of vision, place the person 
under examination with his back to a window at a distance of 20 feet 
from the test types. Examine each eye separately, without glasses, 
covering the other eye with a card (not with the hand). The 
applicant is directed to read the test types from the top of the chart 
down as far as he can see and his acuity of vision recorded for each 
eye, with the distance of 20 feet as the numerator of a fraction and 
the size of the type of the lowest line he can read correctly as the 
denominator. If he reads the 20-feet type correctly, his vision is 
normal and recorded 20/20; if he does not read below the 30-feet 
type, the vision is imperfect and recorded 20/30; if he reads the 15- 
feet type, the vision is unusually acute and recorded 20/15, etc. 

19. Registrants who on examination are found to present the fol¬ 
lowing conditions, who are otherwise mentally and physically lit, 
shall be unconditionally accepted for general military service: 

(«) Normal vision. 

(&) Minimum vision of 20/100 in one eye and 20/40 in other eye 
without glasses; or 20/100 in each eye without glasses, if correctable 
with glasses to 20/40 in either eye. 

( c) Conditions due to iridectomy or other operation upon the 
eye if the condition for which the operation was' performed has been 
relieved, and the vision is within or above the minimum standard 
requirements. 

(d) Slight nystagmus. 

( e ) Slight conjunctivitis. 

(/) Chronic simple conjunctivitis occurring in regions where 
trachoma is not prevalent, and if easily remediable. 

(g) Slight adhesion of the lids to the eyeball. 

( h ) Small pterygium. 

( i ) Slight injection of lids. 

( j) Ptosis which does not interfere with vision. 

(k) Strabismus which does not interfere with vision. 

53291°—IS-2 


6 


(?) Color blindness. (Color blindness should be indicated on Form 

1010 .) 

20. Registrants who on examination are found to present the fol¬ 
lowing remediable defects who are otherwise mentally and physically 
fit, may be conditionally accepted for general military service in the 
deferred remediable group. 

(a) Chronic conjunctivitis occurring in districts where trachoma 
is prevalent. 

(b) Inversion of eyelids. 

(c) Eversion (marked) of eyelids. 

( d ) Ptosis interfering with vision. 

(e) Trichiasis. 

(/) Epiphora. 

(g) Chronic blepharitis. 

(A ) Extensive pterygium. 

(i) Chronic dacryocystitis. 

()) Blepharospasm. 

(/»;) Superficial corneal ulcer. 

(?) Acute inflammatory diseases of the eyeball. 

21. Registrants who on examination are found to present the fol¬ 
lowing defects, who are otherwise mentally and physically fit may 
be accepted for special and limited military service: 

(a) A minimum vision of 20/200 in one eye and 20/40 in other- 
(either right or left) without glasses, or 20/200 in each eye without 
glasses if correctable with glasses to 20/40 in either eye. 

(b) Blindness in one eye with normal vision in other eye without 
glasses. 

22. Registrants who on examination are found with the following 
defects shall be unconditionally rejected for all military service: 

(a) Total blindness. 

(b) Vision less than the minimum requirements for special and 
limited military service. 

(c) Disfiguring cicatrices of eyes. 

(d) Lagophthalrnus. 

(e) Pronounced exopthalmus. 

(/) Chronic keratitis. 

(g) Chronic recurrent inflammatory diseases of the globe. 

(A) Deep ulcer of cornea. 

(i) Any organic disease of the retina, choroid, or optic nerve. 

(j) Detachment of the retina. 

(k) Marked nystagmus. 

(?) Loss or disorganization of either eye with less than normal 
vision in remaining eye. 

(m) Glaucoma. 


7 


(n) Diplopia due to paralysis of the extrinsic ocular muscle. 

(o) Abnormal conditions of eyes due to diseases of the brain. 

( p ) Malignant tumors of lids or eyeballs. 

(q) Trachoma. 

23. When the physicians of the Local Boards are not supplied with test 
glasses and there is no opportunity for the Local Boards to secure 
an examination of the registrants’ eyes with test glasses, they should 
he referred to the Medical Advisory Boards. 

24. Local Boards should encourage oculists and aurists to serve as vol¬ 
untary assistants in the examination of the eyes and ears of registrants. 

25. Local Boards shall refer all suspected cases of trachoma to the 
Medical Advisory Board. 

VISUAL TESTS FOR THE DETECTION OF MALINGERERS. 

26. Malingerers may feign inability to open their eyes, total loss 
of vision in one or both eyes, or impaired vision in one or both eyes. 
Occasionally an inflammation in the eyes will be produced b}^ putting 
sand or other irritating substance under the lids. 

27. .Malingerers who wish tQ evade military service by feigning 
impairment of vision may be divided into two classes as follows: 

(a) Those who claim total loss of vision in one eye. 

(b) Those who claim partial loss of vision in one or both eyes. 

Either group may have a normal acuity of vision or may exag¬ 
gerate a defect actually present. 

28. In testing for malingering the medical examiner should bear 
in mind that detection is more likely to result when the man is 
allowed to believe that his case is regarded from the first as genuine 
and that his story is not discredited. There is something indefinable 
in the bearing of the malingerer which experience alone can detect. 
He may be self-assertive and overconfident; he may be hesitating or 
evasive. Careful observation should be made of his conduct and every 
movement noted. The nature of the man's answer should be taken 
into account and considered in the light of the kind of reply that is 
given when a genuine refraction case is being dealt with. 

29. The following equipment is necessary : 

.Trial frame; blank; spherical lenses, +16, +3, +0.25, —3, —2, 
—1, -0.25. 

Two prisms, one 6° and one 10°. 

Ophthalmoscope (electric battery in handle). 

Condensing lens. 

Loupe. 

Ked and green letters on glass; (a) letters varying in size; (b) 
spectacle frame containing red and green glasses. 


8 


Special test cards, one a duplicate, with letters reversed to use with 
a mirror. 

Special illiterate test cards. 

Mirror, large enough to reflect test cards. 

One stereoscope with special card. 

Ketinoscope (electric, with battery in handle). 

Ruler, about 1J inches wide. 

METHODS OF EXAMINATION. 

Class A. Total Loss of Vision in One Eye. 

30. (a) A 6° prism base downward is placed before the admittedly 
sound eye, while the man looks at a distant light or candle. If he 
sees two candles, binocular vision is proved. The examiner may 
vary the test by placing the prism before the “ blind ” eye, either base 
up or base down. 

( b ) A prism of 10°, with base outward, is placed before the 
a blind ” eye. If there is any sight in this eye, double vision will be 
produced and the eye will be seen to move inward to correct it and 
fuse the two images. 

( c ) The alleged “blind” eye is covered: A prism of 10°, with the 
apex up, is placed before the “ seeing ” eye in such a position that its 
edge lies horizontally across the center of the pupil. This produces 
monocular diplopia. The prism is then moved upward so as to be 
completely in front of the good eye and at the same time the “ blind ” 
eye uncovered. If diplopia is produced or admitted there is sight 
*n the “ blind ” eye. 

(d) Test with colored glasses and letters: This consists in directing 
the individual to read a row of red and green letters through a red 
and green glass. The red letters will be invisible to the eye that has 
the green glass, and vice versa, but if all the letters are correctly read 
irrespective of their color there must be sight in the “ blind ” eye. 
The proper illumination back of the chart must be observed. 

( e ) Test with trial glasses: A high-plus glass is placed before the 
good eye and a low plus or minus before the “blind” eye. If the 
distant type is read the vision in the “ blind ” eye is good. 

(/) The stereoscopic test: This may be made with ordinary stereo¬ 
scope, the printed matter so arranged that certain portions of it are 
not present before one of the eyes. 

(g) The bar test: Interpose a ruler about !j inches wide vertically 
midway between the two eyes at about 4 to.5 inches distance; direct 
the man to read from a printed page with lines at least 4 inches long. 
If able to read the lines, binocular vision exists. 

(h) The action of the pupil must be carefully tested, there usually 
being no movement to light stimulation when the eye is blind. If 


9 


the examiner is not satisfied, the following examination should bo 
made: 

Oblique examination: A careful examination of the cornea should 
be made with the aid of a condensing lens and a loupe. 

Ophthalmoscopic examination: A searching examination with the 
ophthalmoscope should be made, together with an estimation of the 
refractive error. The pupil should be dilated if necessary. 

Class B.—Partial Loss of Vision in One or Both Eyes. 

31. The most common manifestation of malingering takes the form 
of a statement that one eye is imperfect. Men pleading this disability 
may be divided into two classes: (1) Those who pretend to have a 
visual defect; (2) those who are aware they have a visual defect and 
exaggerate its effect. 

No hard-and-fast tests can be prescribed for the detection of these 
cases. Much depends on the alertness and ingenuity of the medical 
examiner. 

The tests with prisms are not applicable here, for there is not pre¬ 
tended blindness in one e} r e, but simply an alleged diminution of 
visual acuity. 

(a) If a room 30 or 40 feet long can be obtained for testing vision, 
place the registrant suspected of malingering at 30 to 35 feet from 
the test chart. Direct him to read the letters and note the result. 
He should then be brought up to 20 feet from the card and retested. 
If he reads the same line he is malingering. 

(h) Mirror tests with special test cards. 

Test cards are used which are identical, one having letters re¬ 
versed. The registrant is directed to read the letters on the chart 
across the room, and theft in a mirror beside it, which reflects reverse 
letters that are placed over his head. The letters seen in the mirror 
are located double the distance of the direct letters from the man 
being examined. The malingerer is apt to read in the mirror the 
line which he read on the first card, showing that his vision is twice 
as good as he pretends. 

In order to obviate the use of test letters in the mirror test, various 
common objects approximating the size of the 20/40 and 20/30 
letters may be used by asking a registrant to differentiate between 
a dime and penny, a cigarette and pencil, a pen and pencil, the num¬ 
ber of spots on playing cards, or between the different aces, held on 
• either side of his head and reflected in the mirror at 20 feet distance. 

Trial frame test: Place a trial frame upon the man’s face and put 
before the sound eye a high convex lens (+16D), and before the 
“blind” eye a plane or weak lens (0.25) which will not interfere 


10 


with vision. If letters placed at distance of 20 feet are read, the 
fraud is at once exposed. 

(c) Oblique examination with condensing lens and loupe to deter¬ 
mine corneal or lenticular opacities. 

(cl) Ophthalmoscopic examination: It is probable that the malin¬ 
gerer will resist the ophthalmoscopic examination by frequent wink¬ 
ing or rolling of the eyes. In this event it is best to caution the man 
that a report of his vision must be made, and then to postpone 
further examination until after the next few registrants have been 
examined. 

(e) Estimate the refractive error with the use of the ophthalmo¬ 
scope. If no error of marked degree exists and the media and fundi 
are normal, the relation between the alleged vision and the refractive 
condition furnishes an important clue. If the error is about +4 or 
—2, the visual acuity could be about 20/100, but when the defect can 
not be accounted for objectively and the vision is brought from 
20/100 to 20/50 or 20/30 by means of a low plus or minus glass, the 
man is malingering. 

(/) Retinoscopy: Look for corneal and lenticular opacities and 
estimate refractive errors. 


occupation. 

32. The man’s occupation in civil life may have been such that it 
could not have been followed without more vision than he claims. 

In the absence of ocuhtr defects, continuous and persistent blephar¬ 
ospasm, the use of colored glasses, eye shades, or eye bandages should 
be regarded with suspicion. 

DIPLOPIA. 

33. Cases of malingering are occasionally met with in which the 
men complain that they see double. These must be investigated with 
the application of the ordinary tests as if they were genuine, with 
every precaution taken to guard against a serious nervous lesion 
being overlooked. 

IV. EARS. 

34. Rearing. —Place the registrant facing away from the assistant, 
who is 20 feet distant, and direct him to repeat promptly the words 
spoken by the assistant. If the registrant can not hear the words 
at 20 feet, the assistant should approach foot by foot, using the 
same voice, until the words are repeated correctly. Examine each . 
ear separately, closing the other ear by pressing the tragus firmly 
against the meatus; the examiner should face in the same direction 
as the registrant and close one of his own ears in the same way as a 
control. The assistant should speak in a low conversational voice 


11 


(not a whisper), just plainly audible to the examiner, and should use 
numerals, names of places, or other words or sentences until the con¬ 
dition of the applicant’s hearing is evident. The acuity of hearing 
should be expressed in a fraction, the numerator of which is the 
distance in feet at which the words are heard by the registrant and 
the denominator the distance in feet at which the words are heard 
by the normal ear; thus, 20/20 indicates normal hearing, 10/20 par¬ 
tial hearing of a degree indicated by the fraction. If any doubt as to 
the correctness of the answer is given, the registrant should be blind¬ 
folded and a watch should be used, care being taken that the indi¬ 
vidual does not know the distance from the ear at which it is being 
held. The watch used should be one whose ticking strength has been 
tested by trial on a normal ear. 

35. Kegistrants who on examination present the following condi¬ 
tions, w T ho are otherwise mentally and physically fit, shall be uncon¬ 
ditionally accepted for general military service. 

(a) Normal hearing. 

(b) Hearing in each ear of 10/20 or better. 

36. Kegistrants who on examination present the following defects, 
who are o-herwise mentally and physically fit, may be accepted for 
special and limited military service: 

(a) Deafness in one ear with normal hearing in the other ear. 

(b) Hearing in one or both ears less thanT0/20 but more than 
5/20. 

(c) Perforation of membrana tympani without discharge, defi¬ 
nitely determined by otoscopy. 

( d ) Loss of one or both external ears, if the registrants have fol¬ 
lowed a useful vocation in civil life and the deformity is not too 
greatly disfiguring. 

37. Kegistrants who on examination present the following defects 
shall be unconditionally rejected for all military service: 

(a) Hearing in one or both ears of less than the minimum hearing 
required for special and limited military service. (See 21 (b).) 

(b) Chronic purulent otitis media, with or without mastoiditis. 

38. The Local Boards shall refer to the Medical Advisory Boards all 
registrants who are found giving a?history of chronic discharge, or have 
a chronic discharge of the middle ear or ears. All registrants whose 
hearing is in doubt should be referred to the Medical Advisory Boards. 

TESTS FOR MALINGERING IN HEARING. 

39. Individuals who are malingerers in regard to hearing usually 
claim magnifications of slight imperfections on one side with a com¬ 
plaint of past Double. Exaggeration of defects in hearing extends 
usually to declarations of total deafness on one side. 


12 

40. The following directions should be observed in examining 
suspected malingerers: 

(a) In making these examinations the observer should have a 
skilled assistant, and all communications between them should be in 
a low whispered voice. 

( b) The assistant should stand at the back of the patient and 
should at the direction of the examiner obstruct the ears of the sus¬ 
pect as directed, by pressing the tragus firmly into the auditory 
meatus. 

(c) The suspected malingerer should be placed in the center of the 
room, free from all obstructions. His eyes should be* securely and 
completely blindfolded. 

(cl) An accurate notation should be made of which ear is deaf as 
claimed by the registrant. Then a critical examination of the auditory 
canal, membrana tympani, and for the patulency of the Eustachian 
tubes should follow. 

(e) Then an accurate test of the normal ear should be made. Care 
should be exercised not to allow the suspect to hear figures or other 
signs as to the result of examination. 

(/) If the suspect gives markedly conflicting statements when the 
normal ear is tightly plugged as to the distance at which he hears 
the voice or accumeter, it is fair to assume he is a malingerer. 

(g) The simplest and most available test for malingering is the use 
of an ordinary binaural stethoscope. One earpiece, the one to be ap¬ 
plied to the normal ear, is packed tightly with a wad of absorbent cot¬ 
ton, and the earpieces are placed in the suspect’s ears. The examiner 
speaks in a soft tone or counts into the bell-shaped chest portion of 
the stethoscope, and the suspect is told to repeat what he hears. The 
tubes are removed from the ears, and the assistant is told to stop the 
normal ear. The same words or numerals are again repeated. The 
suspect will now claim failure to hear the words or numerals which 
he had previously heard through the tube with the ear stated to be 
deaf. 

( h ) Erhard’s test is another simple method for malingerers which 
requires no special apparatus. If the external auditory canal of a 
normal ear is tightly packed with absorbent cotton, it will still 
conduct sound waves to a limited degree; a loud-ticking ’watch even 
under these circumstances being heard about 1 or 2 meters. The 
suspect has his ear which is stated to be deaf stopped, and then the 
test is made with the hearing of the normal ear, the suspect being 
told to count the ticks of the watch. The suspect’s normal hearing 
ear is then stopped and the testing is made with the supposed deaf 
ear. Under this test, if he claims failure to hear the watch under 1 
meter, he is malingering. 


13 


(i) The Chiman-Moos test is made with the C2 tuning fork. The 
vibrating tuning fork is held at equal distances from each ear. The 
suspect may claim that he hears it better in the normal ear. The vi¬ 
brating tuning fork is then placed on the vertex of the skull. The 
suspect hearing it equally well in both ears will at first hesitate and 
then state he hears it better in the normal ear. In diseases of the con¬ 
ducting apparatus he should hear it better in the diseased ear. If, 
now the external meatus of the normal ear is tightly closed and the 
vibrating tuning fork is placed upon the vertex of the skull, the in¬ 
dividual with the diseased ear will state he hears it better in the 
normal closed ear; or, it may be impossible for him to decide in which 
ear he perceives the tone better. The suspect, with the normal ear 
tightly obstructed, will state that he does not perceive the sound of 
the fork when thus placed on the vertex of skull. 

V. MOUTH, NOSE, FAUCES, PHARYNX, LARYNX, TRACHEA, 
AND ESOPHAGUS. 

41. Registrants who on examination are found to present the fol¬ 
lowing conditions, who are otherwise mentally and physically fit, 
shall be unconditionally accepted for general military service: 

(a) Normal conditions of the mouth, nose, fauces, pharynx, larynx, 
trachea, and esophagus. 

(b) Enlarged tonsils. 

( c ) Adenoids. 

(d) Small benign tumors of the nasal and buccal mucous mem¬ 
brane. 

( e ) Deviation of the nasal septum which does not seriously inter¬ 
fere with nasal breathing. 

(/) Acute primary sinusitis provided the acceptance of the regis¬ 
trant is temporarily deferred for reexamination, if after a reasonable 
time the sinusitis has disappeared. 

(g) Laryngitis manifested by hoarseness, laryngeal cough, and 
congestion of the vocal chords, confirmed by laryngoscopy. 

(h) Paralysis of the vocal chords, if it appears to be temporary in 
character. 

(i) Aphonia without objective findings by laryngoscopy or other 
measures, and which in the opinion of the examiners is due to func¬ 
tional nervous conditions. 

( j ) Alleged stricture of the esophagus which is unattended by 
evidence of organic disease of the esophagus as shown by the passage 
of a stomach tube or an esophageal bougie, or by a fluoroscopic exam¬ 
ination while the registrant is swallowing a bismuth mixture. 

42. Registrants who on examination present the following reme¬ 
diable defects, who are otherwise mentally and physically fit, may 

53291°—IS-3 


14 


be conditionally accepted for general military service in the deferred 
remediable group: 

(a) Deviation of the nasal septum which seriously interferes 
with nasal breathing. 

43. Registrants who on examination present the following defects, 
who are otherwise mentally and physically fit, may be accepted for 
special and limited military service: 

(a) Paralysis of the vocal chords, and which does not appear tem¬ 
porary in character, if it permits the registrants to follow a useful 
vocation in civil life. 

(b) Aphonia, with attendant conditions, which disqualify for 

general military service, if they have followed a useful vocation in 
civil life. vy. 

(c) Partial ankylosis of the lower jaw. 

( d ) Perforation of the hard palate. 

( e ) Moderate deformity of the structures of the mouth which 
does not seriously interfere with mastication or speech. 

44. Registrants who on examination present the following defects 
shall be unconditionally rejected for all military service: 

(a) Irremediable deformities of the mouth, throat, and nose 
which interfere with the mastication of ordinary food, with speech, 
or with breathing. 

(b) Tuberculosis of the structures of the mouth, larynx, fauces, 
nose, or esophagus. 

(c) Cancer of the structures of the mouth, nose, throat, larynx, 
or esophagus. 

(d) Destructive syphilitic diseases of the mouth, nose, throat, 
larynx, or esophagus. 

( e) Laryngeal paralysis, due to pressure from aneurysm or 
tumor. 

(/) Permanent tracheostomy. - « 

(g) Stricture of the esophagus. n 

(h) Permanent gastrostomy. 

( i ) Chronic sinusitis of the accessory sinuses of the nose. (The 
diagnosis should be established upon chronic nasal discharge, pres¬ 
ence of large nasal polypi, and other signs and symptoms rein¬ 
forced by transillumination or X-ray plate, or both.) 

45. When the Local Boards are in doubt concerning the physical fit¬ 
ness of registrants who suffer from defects of the mouth, nose, fauces, 
pharynx, larynx, and esophagus, they should be referred to the Medical 
Advisory Boards. 

46. Local Boards and Medical Advisory Boards should make use of 
laryngoscopy, transillumination of the head, and X-ray plates, when 
available to determine more definitely the physical fitness of registrants 
who have defects involving the upper air passages, head, or esophagus. 


.15 


VI. DENTAL REQUIREMENTS. 

47. Registrants who on examination are found to present the fol¬ 
lowing conditions, if otherwise mentally and physically fit, shall be 
unconditionally accepted for general military service: 

(a) Normal teeth. 

(b) A minimum of three serviceable natural masticating teeth 
above and three below opposing and three serviceable, natural in¬ 
cisors above and three below opposing. (Therefore, the minimum 
requirements consist of a total of six masticating teeth and of six in¬ 
cisor teeth. All of these teeth must be so opposed as to serve the 
purpose of incision and mastication.) 

48. Registrants who on examination are found to present the fol¬ 
lowing defects, who are otherwise mentally and physically fit, may 
be accepted for special and limited military service: 

(a) Dental defects which arc greater than the minimum dental 
requirements for general military service. 

DEFINITIONS. 

49. («) The term “ masticating teeth ” includes molar and bicuspid 
teeth, and-the term “ incisors” includes incisor and cuspid teeth. 

(b) A natural tooth which is carious (one with a cavity) which 
can be restored by filling is to be considered as a natural serviceable 
tooth. 

( c ) Teeth which have been (see (&)) restored by crowns or 
dummies attached to fixed bridge work, if well placed, shall be 
considered as serviceable natural teeth, when the history and the 
appearance of these teeth is such as to clearly warrant such 
assumption. 

(cl) A tooth is not to be considered a serviceable, natural tooth 
when it is involved with excessively deep pyorrhea pockets or when 
its root end is involved with a known infection that has or has not 
an evacuating sinus discharging through the mucous membrane or 
skin. 

50. Physicians and dentists of Local Boards and Medical Advisory 
Boards are urged to advise and to aid registrants with remediable carious 
teeth and infected dental roots and other dental defects, to have them 
remedied pending orders. 

51. Instruct them that all hopelessly diseased teeth should be extracted. 
Chronic focal infections involving the teeth and jaws should be eradicated 
and all tooth cavities should be filled. This preliminary remediable dental 
work will greatly assist the dentists of the cantonments in completing the 
routine necessary dental work. The correction of the focal infection 
about the mouth will protect the registrants from possible systemic com¬ 
plications which are liable to occur under the strain of military training. 


16 


52. When the physicians of the Local Boards are in doubt concerning 
dental defects of registrants, they should refer them to the Medical 
Advisory Boards. 

VII. SKIN. 

53. Registrants who on examination are found to present the fol¬ 
lowing conditions, if otherwise mentally and physically fit, shall be 
unconditionally accepted for general military service: 

{a) Normal skin. 

(b) Acute diseases of the skin which ordinarily run a temporary 
course. 

(c) Diseases which are trivial in character and which do not inter¬ 
fere with the general health and are not incapacitating. Among 
these common and usually trivial diseases may be enumerated: 

Acne. 

Anomalies of pigmentation. 

Scars not extensive, disfiguring, or incapacitating in character. 

Condylomata which are not extensive. 

Diseases of the skin caused by pus infection. 

Acute eczemas. 

Naevi which are not greatly disfiguring. 

xill forms of pediculosis. 

All forms of ringworm. 

Scabies. 

Mild and not extensive psoriasis. 

Warts. 

The secondaiy syphilitic lesions of the skin. 

Registrants who are accepted for general military service with tem¬ 
porary remediable defects in the form of parasitic and other communi¬ 
cable diseases of the skin should have this fact noted on Form 1010. 

54. Registrants who on examination are found to present the fol¬ 
lowing remediable defects, if otherwise mentally and physically fit, 
may be conditionally accepted for general military service in the 
deferred remediable group: 

(a) Large ulcers or other defects of the skin which when cured 
will fit the registrants for general military service. 

55. Registrants who on examination are found to present the fol¬ 
lowing defects, who are otherwise mentally and physically fit, may 
be accepted for special and limited military service: 

(a) Defects due to diseases of the skin, either acute or chronic, 
which disqualify for general military service, if they have success¬ 
fully followed a useful vocation in civil life. 

56. Registrants who on examination present the following defects 
of the skin shall be unconditionally rejected for all military service: 


17 


(a) Long existing skin diseases or long existing ulcers of the skin 
which are so severe, or so disfiguring as to incapacitate the regis¬ 
trant for the duties of a soldier, or so disfiguring as to render the 
registrant objectionable in common social intercourse. 

( b) Actinomycosis. 

(<?) Dermatitis herpetiformis of long duration. 

(cl) Epidermolysis bullosa. 

( e) Forms of universal dermatitis of long duration. 

(/) Glanders. 

((/) Idiopathic multiple hemorrhagic sarcoma. 

(h) Mycosis fungoides. 

( i) Pemphigus chronicus of long duration. 

(j) Pemphigus foliaceous. 

(7c) Pemphigus vegetans. 

(l) Cancer, including pigmented moles undergoing degeneration. 

(m) Lupus. 

(n) Syphilitic lesions ulcerative in character showing much de¬ 
struction of tissue which if healed would be unsightly or so scarring 
as to incapacitate the registrants for military service. 

57. When the Local Boards are in doubt concerning the physical fit¬ 
ness of registrants who suffer from defects due to diseases of the skin, 
they should refer them to the Medical Advisory Boards. 

VIII. HEAD. 

58. Registrants who on examination are found to present the fol¬ 
lowing conditions, if otherwise mentally physically fit, shall be 
unconditionally accepted for general military service: 

(a) Normal skull. 

(b) Moderate deformities of the bones of the skull of the char¬ 
acter of depressions, exostoses, etc., and unassociated with evidence 
of disease of the brain, spinal cord, or peripheral nerves, and which 
do not prevent the registrant from wearing military headgear. 

(c) Defects which are apparently temporary in character due to 
recent injuries. (This includes contusions and other wounds of the 
scalp and concussion. Registrants with these defects should have the 
final examination temporarily deferred.) 

59. Registrants who on examination are found to present the fol¬ 
lowing defects, who are otherwise mentally and physically fit, may 
be accepted for special and limited military service; 

(a) Decompression operation of the skull unasscciated with 
marked bulging at the site of operation. 

60. Registrants who on examination are found to present the fol¬ 
lowing defects shall be unconditionally rejected for all military service: 


18 


(a) Deformities of the skull of the nature of depressions, exos¬ 
toses, etc., of a degree which will prevent the registrants from wear¬ 
ing military headgear. 

(b) Deformities of the skull of any degree associated with evi¬ 
dences of disease of the brain, spinal cord, or peripheral nerves. 

/ * * 

IX. SPINE. 

61. Registrants who on examination are found to present the fol¬ 
lowing conditions, who are otherwise mentally and physically fit, 
shall be unconditionally accepted for general military service; 

(a) Normal spine. 

(b) Lateral curvature of the spine of 2 inches or less from the 
normal mid line, if the mobility and weight-bearing power are good. 

( d) Temporary defects in the form of recent contusions or sprains 
of the spinal column. 

( e ) Pilo-nidal sinus (this usually presents itself in the region 
between the coccyx and anus) if unattended with disease of the bone 
as shown by an X ray plate. 

(c) Fracture of the coccyx. 

62. Registrants who on examination are found to present the fol¬ 
lowing defects, who are otherwise mentally and physically fit, may 
be accepted for special and limited military service: 

(a) Lateral deviation of the spine from the normal mid line of 
more than 2 inches and less than 3 inches. 

(b) Nontuberculous diseases of the spine which are unassociated 
with such rigidity that the registrant has been incapacitated from 
following a useful vocation in civil life. 

(c) Fracture of the spine or pelvic bones which have healed 

without defects and which have not interfered with their following 
a useful vocation in civil life. *-i 

63. Registrants who on examination are found to present the fol¬ 
lowing defects shall be unconditionally rejected for all military service: 

(a) Extensive disease of the vertebrae. 

(b) Tuberculosis of any portion of the vertebral column. 

( c ) Abscess of the spinal column. 

(d) Osteoarthritis, partial or complete, of the spinal column. 

( e ) Healed fractures of the vertebrae or pelvic bones with associ¬ 
ated disqualifying rigidity. 

(/) Lateral deviation of the spine from the normal mid line of 
more than 3 inches. 

64. When the Local Boards are in doubt concerning the physical fit¬ 
ness of registrants who suffer from deformities and diseases of the spine, 
they shall refer them to the Medical Advisory Boards. 


19 


65. Registrants who appear for examination wearing a plaster jacket 
should be referred to the Medical Advisory Boards. The jacket should 
not be removed until provision shall have been made for its reapplication. 

66. When the physicians of the Local Boards and the Medical Advisory 
Boards are in doubt concerning the cause and the extent of the diseases 
of the vertebrae, an X-ray plate of the spine should be made. 

SACRO-ILIAC AND LUMBO-SACRAL JOINTS. 

67. Registrants who on examination are found to present the fol¬ 
lowing conditions, if otherwise mentally and physically fit, shall be 
unconditionally accepted for general military service: 

(a) Normal sacro-iliac and lumbo-sacral joints. 

(b) Complaint of disease of the sacro-iliac and lumbo-sacral 
joints which is unassociated with objective signs and symptoms at 
the first examination and which, on reexamination, after a reasonable 
period of time, is again found negative. 

68. Registrants who on examination are found to present the fol¬ 
lowing defect, if otherwise mentally and physically fit, may be 
accepted for special and limited military service: 

(a) Disease of the sacro-iliac and lumbo-sacral joints of a degree 
which disqualifies for general military service, if otherwise mentally 
and physically fit and if the registrants have followed a useful voca¬ 
tion in civil life. 

69. Registrants who on examination are found to suffer from the 
following defect shall be unconditionally rejected for all military 
service: 

(a) Disease of the sacro-iliac and lumbo-sacral joints which is of a 
chronic type and is obviously associated with pain referred to the 
lower extremities, muscular spasm, postural deformities, and limita¬ 
tion of motion in the lumbar region of the spine. 

70. When the Local Boards are in doubt concerning the physical fitness 
of registrants who suffer from disease or other defects of the sacro-iliac 
or lumbo-sacral joints, they shall be referred to the Medical Advisory 
Boards. 

71. When the physicians of the Local Boards and Medical Advisory 
Boards are in doubt, they should have an X-ray plate made of the sacro¬ 
iliac and lumbo-sacral joints. 

X. SCAPULAE. 

72. Registrants who on examination are found to present the fol¬ 
lowing conditions, if otherwise physically and mentally fit, shall be 
unconditionally accepted for general military service: 

(a) Normal scapulae. 

(b) Prominent scapulae due to other causes than paralysis. 


20 


73. Registrants who on examination are found to present the fol¬ 
lowing defect, if otherwise physically and mentally fit, may be 
accepted for special and limited military service: 

(a) Prominent scapulae clue to paralysis of a degree which has not 
prevented the applicant from following a useful vocation in civil life. 

74. Registrants who on examination are found to present the fol¬ 
lowing defect shall be unconditionally rejected for all military service: 

(a) Prominent scapulae due to paralysis. 

XL THE EXTREMITIES. 

75. Registrants who on examination are found to present the fol¬ 
lowing conditions shall be unconditionally accepted for general mili¬ 
tary service. 

(a) Normal upper and lower extremities with normal function. 

(b) Ancient or recent fractures wdiich have healed spontaneously 
with no resulting impairment of function. 

(c) Ancient or recent compound fractures or simple fractures of 
bone which have been operated upon and fixed by any mechanical 
measure with resulting good function. 

(d ) Benign tumors of bone when the condition does not interfere 
with the function of the extremity or the joint involved. (Benign 
tumors referred to are single and multiple exostoses and healed 
benign cysts.) 

( e ) Defects due to the removal of a benign tumor or tumors of 
bone which do not interfere with the function of the extremity. 
(Benign tumors referred to are single and multiple exostoses, healed 
benign bone cysts, enchondroma, and the giant celled tumor.) 

(/) Recent injury of a bone or joint with or without fracture or 
dislocation which in the opinion of the examiners is only temporarily 
incapacitating. (Registrants with these defects should be given a 
period of time not less than six weeks for recovery before the final 
examination is made.) 

(g) Defects of bone or joint of healed tuberculosis when the tuber¬ 
culosis has not shown evidence of activity at any time during the 
period of 10 years immediately preceding the examination. 

(A) Absent left thumb. 

(i) Loss of one finger of either hand with the exception of the 
right index finger. 

( j ) Scars and deformities of moderate degree of the hand or hands 
which do not interfere with normal function. 

(A) Stiff fingers of a degree not to interfere with function. 

(1) A low or even absent longitudinal arch if the foot is otherwise 
practically normal in shape and flexibility. 


21 


(m) Slight hallux valgus which is unassociated with exostoses or 
bunion of any size. 

( n) Clubfoot of slight degree if the deformity has been corrected 
to the degree that the tarsus,'metatarsus, and phalanges are flexible 
and the condition permits the wearing of a military shoe. 

(o) Slight claw toes not involving obliteration of the transverse 
arch and which do not interfere with the wearing of a military shoe. 

(p) Hammer toe which is flexible and which does not interfere 
with the wearing of a military shoe. (Hammer toe usually involves 
the second digit and unless it is rigid is not a disqualifying defect.) 

(q) Absence of one or two of the small toes of one or both feet 
if the function of the foot is good. 

(r) Ingrowing toenails. 

76. Registrants who on examination present the following reme¬ 
diable defects, who are otherwise mentally and physically fit, may be 
conditionally accepted for general military service in the deferred 
remediable group: 

(а) Ununited fractures if in the judgment of the examiners they 
are remediable with resulting good function. 

(б) Benign tumors of bone or joint which interfere with function 
and which in the judgment of the examiners are remediable. 

(<?) Ganglion and other benign tumors of the hand or fingers. 

( d) Abduction and pronation (knock-ankle) when this condition 
is not associated with rigidity of the tarsal joints or with deformity 
of the foot. (This defect is remediable with proper foot exercise 
and with proper shoes.) 

( e) Hammer toe with rigidity. 

(/) Other defects which in the opinion of the examiners are remedi¬ 
able. 

77. Registrants who on examination are found to present the fol¬ 
lowing defects, who are otherwise mentally and physically fit, may be 
accepted for special and limited military seryice: 

(a) Loss of thumb or index finger of right hand. 

(b) Loss of two fingers of either hand, including the right index 
finger. 

( c ) Web fingers. 

(d) Moderate deformities of one or both upper extremities which 
do not and have not interfered with function to a degree to prevent 
the registrant from following a useful vocation in civil life. 

(e) Defects of the foot which disqualify for general military serv¬ 
ice but do not prevent the registrants from wearing a military shoe 
and which have not prevented them from following a useful vocation 
in civil life. 

(/) Web toes. 

53291°—18- 4 



22 


78, Registrants who on examination are found to present the fol¬ 
lowing defects shall be unconditionally rejected for all military 
service: 

(a) Loss of both thumbs. 

(b) Loss of more than two entire fingers of one hand. 

(<?) Extensive disease of long duration of one or more of the 
large joints with or without sinuses. 

(d) Tuberculosis of a bone or joint. (The diagnosis of tuber¬ 
culosis of a bone or joint should be based upon the presence of swell- 
ing, tenderness, muscular spasm, restriction of joint motion, and the 
evidence of bone destruction shown by an X-ray plate.) 

(e) A history of tuberculosis of a bone or joint when the tuber¬ 
culosis has been active at some time during the period of 10 years 
prior to the examination. 

(/) Old, irremediable, ununited fractures or united fractures with 
deformity sufficient to interfere with function. 

(g) Malignant tumors. 

(h) Extensive disease of long duration involving a number of 
joints of the upper and lower extremities. 

(i) Old, unreduced dislocations which have interfered with the 
registrants following a useful vocation in civil life. 

(j) Disease of the shoulder, elbow, or wrist with resulting limita¬ 
tion of motion. 

(k) Disease of bone or joint healed with such resulting deformity 
that the function is disturbed to a degree that it will interfere with 
military service. 

(l) Muscle paralysis or contraction which disturbs function to 
the degree of interference with military service. 

( m) Excessive curvature of the bones of the leg or thigh. 

(n) Excessive curvature of the bones of the forearm or arm which 
would interfere with military drill. 

(o) Excessive knock-knee. 

(p) Excessive bow legs. 

(q) Adherent scars of the skin and soft tissues of an extremity 
which interferes with function. 

(r) Excessive varicose veins. 

( s ) Varicose veins of any degree associated with edema or ulcer 
of the skin. 

( t ) Absent longitudinal arch of the foot associated with one or 
more of the following conditions: 

Limitation of dorsal flexion. 

Rigid metatarsal and subastragaloid joints. 

Rigid toes. 

Marked pronation. 


23 


Prominent scaphoid associated with other disabling foot conditions. 

( u ) Rigidity of the tarsus and metatarsus due to former infec¬ 
tious processes with or without flat foot. 

ty) Obliteration of the transverse arch associated with permanent 
flexion of the small’toes (claw toes). 

(w) Prominence of the plantar surface of the transverse arch espe¬ 
cially when associated with large callosites. 

(a?) Abnormal flaccidity of the foot and toes when associated with 
evident severely painful symptoms. 

(y) Abduction and pronation (knock-ankle) when associated with 
rigidity of the tarsal joints and painful symptoms. 

„ (z) Loss of dorsal flexion of the great toe if of a degree to be of a 
disabling factor in walking. 

( aa) Hallux valgus if severe and associated with exostoses or a 
bunion of any considerable size, especially when there are signs of 
irritation about the joint. 

(bb) Loss of great toe. 

( cc) Loss of more than two small toes of either foot. 

( dd) Club foot of even moderate degree if correction of the condi¬ 
tion has not been sufficient to meet the standard requirements. (See 
par. 23 (n).) 

(ee) Internal derangement of the knee joint due to loose bodies, 
dislocation of the semilunar cartilages or other disease. 

(ff) Disease of the bone or of the hip, knee, or ankle joint which 
seriously interferes with function and weight-bearing power. 

( gg) Deformities due to fracture or other injury which interfere 
with function and weight-bearing power. 

(AA) Sciatica, which is apparently intractable and disabling, to 
the degree of interference with the function of walking and weight¬ 
bearing power. 

79. The selection of registrants with defects of the feet for special or 
limited military service must he left to the judgment of the physicians 
of the Local Boards and Medical Advisory Boards. 

80. It is extremely important that registrants with defects of the feet 
which are not remediable by training and which prevent the inducted 
men from taking proper training, should not be accepted for general 
military service. It is quite as important that defects of the feet, which 
are not disabling, should not be considered disqualifying for general 
military service. 


24 


XII. HEIGHT, WEIGHT, AND CHEST MEASUREMENTS. 

81. Table of standard accepted measurements of height, weight, 
and circumference of chest. 


A. 


B. 


Standard accepted measurements. 


The following variations from the standard shown 
in column A are permissible when the applicant 
is active, has firm muscles, and is evidently vig¬ 
orous and healthy. 


Height. 

Weight. 

Chest measurement. 

Height. 

Weight. 

Chest measurement. 

At ox- 
piration. 

Mobility. 

At ex¬ 
piration. 

Mobility. 

Inches. 

Pounds. 

Inches. 

Inches. 

Inches. 

Pounds. 

Inches. 

Inches. 

G3 . 

124 

31 

2 

63. 

116 

30 

2 

64 

128 

32 

2 

64. 

120 

30 

2 

65 . 

130 

32 

2 

65. 

120 

30 

2 

66 . 

132 

32£ 

2 

66.. 

120 

301 

2 

67. 

134 

33 

2 

67. 

120 

304 

2 

68 .. 

141 

331 

2g 

68. 

121 

30J 

2 

69 . 

148 

334 

24 

69. 

124 

31 

2 

70... 

155 

34* 

2* 

70. 

128 

311 

2 

71. 

162 

34! 

24 

71. 

133 

3l| 

2 

72. 

169 

34^ 

3 

72. 

138 

321 

21 

73. 

176 

351* 

3 

73. 

143 

321 

21 

24 


183 

36i 

3 

74. 

148 

334 

75. 

190 

36| 

31 

75. 

155 

341 

2! 

76. 

197 

37J 

34 

76. 

161 

341 

21 

77. 

204 

374 

3| 

77. 

168 

35| 

3* 

78.. 

211 

38| 

4 

78. 

175 

351 

3 









82. Directions for taking height .—-Use a board at least 2 inches 
wide b}^ 80 inches long, placed vertically, and carefully graduated 
to one-quarter inch between 58 inches from the floor and the top 
end. Obtain the height by placing vertically in firm contact with 
the top of the head and against the measuring rod an accurately 
squared board of about 6 by 6 by 2 inches—best permanently at¬ 
tached to graduated board by a long cord. The registrant should 
stand erect with back to the graduated board, eyes straight to the 
front. 

83. Registrants who on examination present the following condi¬ 
tions, if otherwise mentally and physically fit, shall be unconditionally 
accepted for general military service: 

(a) Those who fall within the accepted standards (A) or mini¬ 
mum requirements (B) for height, weight, and chest measurement 
given in table, paragraph 81. 

(b) Those whose weight is greater than the standards indicated 
for the height (A) provided the overweight is not so excessive as to 
interfere with military training. 

84. Registrants who on examination are found to present condi¬ 
tions not within the accepted measurements for weight and chest 
circumference and mobility given in the table, who are otherwise 


















































25 


mentally and physically fit, may be accepted for special or limited 
military service. 

85. Registrants who on examination are found to present the fol¬ 
lowing defects shall be unconditionally rejected for all military 
service: 

(a) Less than 63 inches in height, except for insular troops. 

(b) Less than 116 pounds in weight, except for insular troops. 

( c) With a chest measurement of less than 30 inches and chest 
mobility of less than 2 inches. 

(■ d) A height of more than 78 inches. 

(e) Overweight which is greatly out of proportion to the height, 
if it interferes with normal physical activity or with proper training. 

86. Local Boards should refer to the Medical Advisory Boards the fol¬ 
lowing registrants: 

(a) Registrants who on examination are found to be apparently 
slightly under the minimum requirements for weight and chest meas¬ 
urements for the height. 

(b) Registrants of 78 inches in height who should be studied for 
the possibility of gigantism or acromegaly. 

( c ) Registrants who are obese. 

(d) Registrants whose weight is less than 116 pounds and the 
defect is due to recent illness or to employment and environment of 
civil life and may be considered remediable by camp life. 

( e ) Registrants whose chest mobility is less than 2, 2-J, or 3 inches, 
respectively, as per the table, that they may be further studied to 
ascertain if the lack of required chest mobility is due to ignorance or 
to lack of practice. 

87. Physicians of Local Boards and Medical Advisory Boards should 
use discretion and judgment in accepting registrants with slight varia¬ 
tions in the ratio of height, weight, and chest measurements indicated 
in the table. Minimum and maximum height are absolute but when the 
weight is disproportionate and is believed to be due to some temporary 
condition, proper allowance may be made, provided it is the opinon of the 
boards that the variation is correctable with proper food and physical 
training. 

XIII. ABDOMEN. 

88. Registrants who on examination are found to present the fol¬ 
lowing conditions, who are otherwise mentally and physically tit 
shall be unconditionally accepted for general military service: 

(a) Normal abdominal wall and abdominal organs. 

(b) Abdominal scars due to surgical operation or accident which 
shoTv no hernial bulging at site of scars. 


26 


(c) Scar pain when found not associated with any disturbance of 
function of abdominal wall, stomach, or bowels. 

(d) Jaundice when this is proved to be of a temporary character 
and not associated with organic disease of the gall tracts or liver by 
observation and re-examination of the registrant over a period of one 
month. 

(e) Complaint of weak stomach, indigestion, dyspepsia, constipa¬ 
tion, belching, vomiting, and various other types and degrees of 
abdominal discomfort which are proven by examination not to be 
associated with organic disease by the absence of the usual objective 
symptoms and signs and by such laboratory tests as may be em¬ 
ployed. 

(/) Blood in stools if proved to be due to slight defects, such as 
fissures of the anus, small hemorrhoids, or superficial small ulcers of 
the rectum. 

(g) Moderate enlargement of the liver unassociated with other 
objective evidence of disease of the liver or other organs. 

(h) Splenic enlargement of moderate degree unassociated with 
evidence cf other disqualifying disease. 

( i ) Moderate enlargement of the spleen due to malaria. 

(/) Small tumors of the abdominal wall (these are usually fibro¬ 
mas in area of recti muscles). 

(7c) Ptosis of the stomach and bowels unassociated with objective 
evidence of disturbance of function of the gastrointestinal tract. 
(Individuals who have ptosis of the stomach and bowels‘usually 
complain of constipation, belching of gas, heaviness in abdomen after 
meals, and numberless symptoms referable to the heart and nervous 
apparatus.) 

(?) Mucous colitis due to spastic constipation. 

(m) Proctitis of simple character confirmed by proctoscopy, which 
is not associated with ulceration of the mucous membrane. 

(n) Intestinal parasites or their eggs in the stools. 

(o) Internal and external hemorrhoids without prolapse of rectum. 

89. Registrants who on examination are found to present the fol¬ 
lowing remediable defects, who are otherwise mentally and physically 
fit, may be conditionally accepted for general military service in the 
deferred remediable group: 

(a) Hernia—inguinal, femoral, umbilical, and postoperative. 

(b) Large benign tumors of the abdominal wall. 

( c ) Jaundice which persists beyond a period of one month and 
is determined at the final examination to be remediable. 

(d) Large internal hemorrhoids with prolapse and hemorrhage. 

(e) Proctitis associated with remediable ulcers. 

(/) Amoebic dysentery. 


27 


90. Registrants who on examination present the following defects, 
who are otherwise mentally and phj^sically fit, may be accepted for 
special and limited military service: 

(a) Ptosis of the stomach and bowels associated with disqualif}dng 
conditions for general military service, but which permit the regis¬ 
trants to follow a useful occupation in civil life. 

91. Registrants who on examination present the following defects 
shall be unconditionally rejected for all military service: 

(a) Inoperable hernia. 

(b) Irremediable diseases of the stomach. 

( c) Irremediable diseases of the bowels. 

(cl) Irremediable diseases of the liver. 

(e) Irremediable diseases of the kidney.; 

(/) Achylia gastrica. 

(q) Gastric succorrhea. 

(A) Jaundice due to irremediable organic disease of the liver. 

( i ) Syphilis of the liver. 

(j) Atrophic cirrhosis of the liver. 

(7c) Hypertrophic cirrhosis of the liver. 

(l) Hydatids of the liver. 

(m) Chronic ulcer of the stomach or duodenum. 

(n) Cancer. 

(o) Partial or complete obstruction of the bowels due to organic 
disease. 

(p) Chronic gastritis secondary to organic disease of other organs. 

(q) Irremediable sinuses of the abdominal wall communicating 
with the hollow viscera. 

(r) Tuberculosis. 

(s) Irremediable stricture of the rectum. 

(t) Multiple fistula? of the anus. 

(u) Schistosomum disease (blood flukes) . 

(^) Enlargement of the spleen associated with leucemia, Hodgkin’s 
disease, or splenic anemia. 

(w) Great enlargement of the spleen from any cause. 

(x) Large internal and external hemorrhoids associated with pro¬ 
lapse of the rectum. 

(y) Paralysis of the sphincter associated with incontinence of 
feces. 

92. When the physicians of Local Beards are in doubt concerning the 
physical fitness of registrants who present defects of the abdominal wall 
or abdominal organs, they shall refer them to the Medical Advisory 
Boards. 

93. When necessary to confirm a diagnosis, the physicians of the Local 
Boards and Medical Advisory Beards should, when possible, avail them- 


28 


selves of fluoroscopy and X-ray plates when examining registrants with 
defects of the abdominal wall or abdominal organs. 

94. When the Medical Advisory Boards are able to command hospital 
facilities, and the necessary diagnostic apparatus, they should, within 
their discretion, use test meals and chemical and microscopic examination 
of the stomach contents and stools. 

95. Physicians of Local Boards and Medical Advisory Boards should 
make use of digital rectal examination of defects referable to that region, 
and when necessary proctoscopy should also be utilized. 

96. Registrants who are found to have parasites or their eggs in stools 
should have this condition indicated on Form 1010. 

97. Moderate impulse produced by cough at the inguinal, femoral, 
[jsgr 3 or umbilical rings, or at the site of a scar is not necessarily indica¬ 
tive of hernia. 


XIV. NECK. 

98. Registrants who on examination are found to present the fol¬ 
lowing conditions, who are otherwise mentally and physically fit, 
shall be unconditionally accepted for general military service; 

(a) Normal neck. 

(b) Nonspastic contraction of the muscles of the neck which is not 
of great degree and will not prevent the wearing of a uniform or 
military equipment. 

( c ) Simple goiter or benign thyroid tumors unassociated with 
toxic symptoms provided the enlargement of the thyroid will not 
interfere with the wearing of a uniform or military equipment. 

(d) Benign tumors and cysts of the neck which will not interfere 
with the wearing of a uniform or military equipment. 

( e ) Small, benign tumors of the parotid gland which will not in¬ 
terfere with the wearing of a uniform or military equipment. 

(/) Enlarged lymph glands of the neck which apparently do not 
interfere with the general health and which are not large enough to 
interfere with the wearing of a uniform or military equipment. 

99. Registrants who on examination are found to present the fol¬ 
lowing remediable defects, who are otherwise mentally and phys¬ 
ically fit, may he conditionally accepted for general military service 
in the deferred remediable group. 

(a) Simple goiter or benign tumors unassociated with toxic symp¬ 
toms but so large as to interfere with wearing a uniform or military 
equipment. 

(b) Enlarged lymph glands of the neck which are so large as to 
interfere with wearing a uniform or military equipment. 

(c) Benign tumors and cysts of the neck which are so large as to 
interfere with the wearing of a uniform or military equipment. 


29 


( d ) Large benign tumors of the parotid gland which, in the opin¬ 
ion of the examiners, may be removed without permanent paralysis 
of the seventh nerve. 

100. Registrants who on examination are found to present the fol¬ 
lowing defects shall be unconditionally rejected for all military service: 

(a) Exophthalmic goiter. 

(b) Thyroid enlargement from any cause associated with toxic 
symptoms. 

(c) Enlargement of the lymph glands of the neck associated with 
all clinical types of leucemia and Hodgkin’s disease. 

(cl) Lynipho-sarcoma. 

( e ) Tuberculous glands. 

(/) Malignant tumors. 

(g) Myxedema. 

( h) Nonspastic contraction of the muscles of the neck which is 
disfiguring and unsightly or interferes with wearing a uniform or 
military equipment. 

( i) Spastic contraction of the muscles of the neck. 

101. When Local Boards are in doubt concerning the physical fitness 
of registrants who present defects of the neck, they should refer them to 
the Medical Advisory Boards. 

102. The physicians of Local Boards and the Medical Advisory Boards 
should reject all registrants who, after careful study, are proved to 
suffer from thyroid toxic symptoms. 

XV. GENITO URINARY ORGANS AND VENEREAL 
DISEASES. 

103. Registrants who on examination are found to present the fol¬ 
lowing conditions, who are otherwise mentally and physically fit, 
shall be unconditionally accepted for general military service: 

(a) Gonorrhea, acute or chronic. 

(b) Syphilis with remediable manifestations. 

( c ) Chancroids and the resulting infection of the lymph glands of 
the groin. (If, in the opinion of the examiners, registrants suffering from 
this defect are in a condition which would make it unsafe to them¬ 
selves and to other soldiers in the cantonment, their induction should 
be temporarily deferred until the condition is improved.) 

(d) Gonorrheal arthritis which is determined to be temporary in 
character and not of itself disqualifying. 

(e) Moderately movable kidney. (By this is meant a kidney which 
upon deep inspiration may be palpated below the costal margins and 
which is not loose within the abdominal cavity.) 

(/) Albuminuria with or without casts which is proved by observa¬ 
tion and repeated examination to be temporary in character. 

(g) Absence of one or both testicles due to removal or atrophy. 

53201°—18 - 5 


30 


(A) Acute cystitis which has proved to be of a temporary char¬ 
acter by observation and repeated examination over a period not to 
exceed six weeks. 

(i) Phimosis with or without adhesions of the mucus surfaces. 

(j) Benign warts and other benign growths of the glans penis 
and of the prepuce. 

(k) Amputation of the penis if a sufficient amount of the organ 
remains so as not to interfere with the function of micturition. 
(Care should be taken to fully examine registrants who present 
evidence of a recurrence of a disqualifying disease for which the 
amputation was made.) 

(l) Varicocele of moderate size. 

( m ) Hydrocele of moderate size, 

( n ) Undescended testicle which lies within the abdominal cavity. 

( o) Bed wetting. 

104. Registrants who on examination are found to present the fol¬ 
lowing remediable defects who are otherwise mentally and physically 
fit, may be conditionally accepted for general military service in the 
deferred remediable group: 

(a) Stricture of the urethra. 

(b) Renal and ureteral calculus verified by an X-ray plate and 
with no evidence of disease of the kidneys. 

(c ) Benign tumor of the testicles. 

(cl) Cystitis which is proved not to be temporary in character and 
which is remediable within the judgment of the examiners. 

(e) benign tumor of the bladder. 

(/) Pyelitis which has been verified by cystoscopy and is deemed 
remediable by the examiners. 

(g) Varicocele of large sie. 

(A) I-Iydrocele of large size. 

105. Registrants who on examination are found to present the fol¬ 
lowing defects shall be unconditionally rejected for all military service: 

(a) Chronic nephritis. (This should be evidenced by the presence, 
in the urine of albumin and casts with or without blood, over a 
period of time sufficient to prove the persistency of the urinary find¬ 
ings. The examiners should require the registrants to void the urine 
during the period of the examination and in the presence of the 
physicians.) When albumin and casts are found in the urine the 
registrants should be reexamined not less than twice on separate 
days. If the urine shows albumin and casts with or without blood 
and this condition of the urine is associated with enlargement of the 
left heart, high blood pressure, and other evidences of cardio-vascular 
disease, the diagnosis of chronic nephritis may be made immediately. 
If the presence in the urine of albumin and of casts with or without 


31 


blood is proved to be inconstant and if the condition is unassociated 
with the cardio-vascular conditions mentioned, decision should lie 
within the judgment and discretion of the examiners. 

(b) Diabetes, evidenced by the presence of glucose in the urine. 
(Reexamination of the urine of registrants which on the first 
examination is found to contain glucose should be made over a 
period of two or three days. The registrants should void the urine 
in the presence of the physicians.) 

( c ) Irremediable stricture of the urethra. 

(d) Urinary fistula. 

( e) Gonorrheal arthritis which is of itself disqualifying. 

(/) Surgical kidney with or without renal calculus. 

(g) Irremediable pyelitis. 

( h ) Cancer. 

(i) Hydronephrosis. 

( j) Tumors of the kidney. 

(k) Tuberculosis of the kidney, ureter, bladder, seminal vesicles, 
or testicles. 

( l) Floating kidney. (By floating kidney is meant one which is 
freely movable within the abdominal cavity). 

(m) Acute nephritis which is proved by observation and reexami¬ 
nation not to be temporary in character. 

(n) Chronic cystitis associated with retention of urine caused by 
stricture of the urethra or by disease of the central nervous system. 

( o ) Amputation of the penis if the resulting stump is insufficient 
to permit of normal function of micturition. 

(p ) Undescended testis which lies within the inguinal canal. 

106. When Local Boards are in doubt concerning the physical fitness 
of registrants who present defects of the genito-urinary apparatus, they 
shall refer them to the Medical Advisory Boards. 

107. When it is deemed necessary, Local Boards and Medical Advisory 
Boards should take advantage of cystoscopy and X-ray examination to 
verify diagnosis of defects of the genito-urinary organs. 

108. Physicians of Local Boards and Medical Advisory Boards should 
advise and aid registrants who suffer from gonorrhea, syphilis, and 
chancroid and temporary remediable defects of the skin to secure proper 
treatment pending orders. 

XVI. MENTAL AND NERVOUS DISEASES. 

109. Registrants who on examination show the following conditions 
shall be unconditionally accepted for general military service: 

(a) A normal nervous system. 

( b ) Who appear to have normal understanding, whose speech can 
be understood, who have no definite signs of organic disease of the 


82 

brain, spinal cord, or peripheral nerves, and who are otherwise 
mentally and physically fit. 

( c ) Hysterical paralyses or hysterical stigmata and local mus¬ 
cular spasms which do not cause mental or physical defects disquali¬ 
fying for general military service. 

(d) Muscular tremors of moderate degree. 

110. Registrants who on examination are found to suffer from the 
following condition, who are otherwise mentally and physically fit, 
may be conditionally accepted for general military service in the de¬ 
ferred remediable group: 

(a) Drug addiction, including the habitual use of opium and its 
derivatives and cocaine. 

111. Registrants who on examination are found to suffer from the 
following defects of the nervous apparatus who are otherwise men¬ 
tally and physically fit may be accepted for special and limited mili¬ 
tary service: 

(a) Stuttering and stammering of a degree disqualifying for gen¬ 
eral military service but which lias not been disqualifying in success¬ 
fully following a useful vocation in civil life. 

(b) Hysterical paralysis or hysterical stigmata of a degree dis¬ 
qualifying for general military service but not of a character to 
prevent the registrants from successfully following a useful vocation 
in civil life. 

( c ) Tremors of such extreme degree that they disqualify for gen¬ 
eral military service but have not prevented the registrants from fol¬ 
lowing a useful vocation in civil life. 

112. Registrants who on examination are found to suffer from the 
following defects shall be unconditionally rejected for all military 
service: 

(a) Insanity. 

(b) Epilepsy. 

( c ) Idiocy. 

(d) Imbecility. 

(e) Chronic alcoholism. 

(/) Stuttering or stammering to a degree that the registrant is 
unable to express himself clearly or to repeat commands or to de¬ 
mand the countersign. 

(g) Constitutional psychopathic state. 

( h ) Chronic essential chorea. 

(i) Tabes (locomotor ataxia). 

(j) Cerebrospinal syphilis. 

(k) Multiple sclerosis. 

(l) Paraplegia. 

(m) Syringomyelia. 

(n) Muscular atrophies and dystrophies. 


33 


(o) Hysterical paralysis or hysterical stigmata so serious that these 
defects are disqualifying for military service. 

(p) Neuritis which is not temporary in character and which has 
progressed to a degree to prevent the registrants from following a 
useful vocation in civil life. 

113. All registrants who suffer from defects involving the 

MENTAL OR NERVOUS SYSTEM CONCERNING WHICH THE LOCAL BOARDS 
ARE IN DOUBT SHOULD BE REFERRED TO THE MEDICAL ADVISORY BOARDS. 

114. The examiners may base their decisions as to mental and 
nervous defects upon the following brief description of some dis¬ 
qualifying defects: 

115. Insanity . —All registrants should be considered insane who 
are committed or who have been committed to a licensed public or 
private institution for the care of the insane. The examiners may 
require proof in the form of verified records of commitment by the 
proper State authorities to verify the statements of the registrants. 

116. Epilepsy. —The registrant shall be declared an epileptic when 
an authentic history of convulsions has been verified by family 
physicians, if this is desired by the examiners, and when the regis¬ 
trant shows scars of the tongue, face, and head, and possibly the 
characteristic voice, to establish the fact that the disease has been 
of long duration. 

117. Idiocy. —A registrant shall be declared an idiot who has been 
so defective in mind from birth or from early age that he is unable 
to guard himself against common physical danger. 

118. Imbecility. —A registrant shall be declared an imbecile who 
has been so defective in mind from birth or early age as to be in¬ 
capable of earning a livelihood but at the same time is able to 
guard himself against common physical danger. 

119. Chronic alcholism. —A registrant shall be declared a suf¬ 
ferer from chronic alcoholism when he presents a majority of the 
following symptoms and signs: Suffused eyes; prominent super¬ 
ficial blood vessels of nose and cheek; flabby, bloated face; red or 
pale purplish discoloration of mucous membrane of the pharynx 
and soft palate; muscular tremor of the protruded tongue and 
extended fingers; tremulous handwriting. 

The history or evidence presented that the registrant has been 
frequently and grossly intoxicated is not of itself sufficient proof 
for the diagnosis of chronic alcoholism. 

CLINICAL FORMS OF INSANITY. 

120. Dementia precox. —Look for indifference, apathy, withdrawal 
from environment, ideas of reference and persecution, feelings of 
the mind being tampered with, of thought being controlled by 


34 


hypnotic, spiritualistic, or other mysterious agencies, hallucinations 
of hearing, bodily hallucinations, frequently of electrical or sexual 
character; meaningless smiles; in general, inappropriate emotional 
reaction and lack of connectedness in conversation. There may be 
sudden emotional or motor outbursts. The history of family life and 
of school, vocational, and personal career will usually show erratic 
and more or less irrational conduct. 

121. Manic-depressive insanity. —Look for mild depression, with or 
without feeling or inadequacy, or mild manic states with exhilara¬ 
tion, talkativeness, and overactivity. 

ORGANIC DISEASES OF THE BRAIN, SPINAL CORD, AND 
PERIPHERAL NERVES. 

122. Paresis (general paralysis). —The diagnosis of paresis may 
be made when at the examination of the registrant a majority of 
the following signs and symptoms are demonstrated: Argyll-Rob- 
ertson pupil or pupils, facial tremor, speech defect in test phrases, 
and in the slurring and distortion of words in conversation; writing 
defects consisting of omissions and the distortion of words. Apa¬ 
thetic or depressed or euphoric mood. These registrants may show 
memory loss, discrepancies in relating facts of life; the knee jerks 
may be plus, minus, or normal. 

123. Tabes (locomotor ataxia). —The diagnosis of this disease 
should be made when, at the examination of the registrant, several of 
the following signs and symptoms are present: Argyll-Robertson 
pupil or pupils; absent knee jerk, Romberg symptom, ataxia of hands 
or legs (especially when the eyes are closed), hypotonia, and anes¬ 
thetic areas of the skin. The history of locomotor ataxia is usually 
that of slow progression, of failing sexual power and pains in the legs 
and back, which are often described as rheumatism. 

124. Cerebrospinal syphilis. —The prominent diagnostic signs and 
symptoms are headache, varying deep and superficial reflexes, pupil¬ 
lary changes, ptosis, and ocular palsies, facial weakness; mental state 
normal, dull, or apathetic. Comparative motor weakness may occur 
of one side of the body or of one extremity. 

125. Multiple sclerosis. —The diagnosis of this disease rests upon 
the following signs and symptoms: Intention tremor, nystagmus, 
absent abdominal reflexes, increased tendon reflexes, and scanning 
speech; in cases of this kind the history obtained is not characteristic, 
but sometimes there may be a history of urinary disturbance. 

126. Paraplegia. —The diagnosis of paraplegia from whatever 
cause will rest upon weakness of the lower extremities, associated 
with lost or increased knee jerk, Babinski reflex, or disturbance of 
the sphincters of the rectum and bladder, with or without girdle 


35 


sensations. Sensory disturbance of the skin may or may not be 
present. Muscle sensibility may be diminished. 

127. Syringomyelia. —Syringomyelia is usually evidenced by more 
or less loss of power and atrophy of groups of muscles of one or more 
extremities; disturbance of the sensations of the skin, more especially 
in the form of analgesias, and diminution of the temperature sense; 
if in the upper dorsal cord, often associated with stooped shoulder 
posture; if in the lower dorsal, with weakness in one or both lower 
extremities. 

128. Muscular atrophies and dystrophies. —The signs and symptoms 
of muscular atrophies and dystrophies are: Atrophies of the small 
muscles of the hand and of the muscle groups of the shoulder; and 
fibrillary twitcliings. The history of these defects rarely furnishes 
reliable data, although it will usually be found that the registrant 
has shown evidences of awkwardness. There is never a history of 
pain in the affected muscles. 

129. Multiple neuritis. —The chief manifestations are more or less 
pain in the course of the affected nerves, with tenderness over the 
trunks of the nerves and of the muscles supplied by them; les¬ 
sened muscular power of varying degrees; more or less atrophy of 
muscles, with or without contraction and evidences of trophic 
changes of the skin. The reflexes, deep and superficial, may be 
diminished or absent; the sphincters are not involved. 

Existent organic nervous disease should always exclude. For ex¬ 
ample, neuritis, of one or many nerves, while susceptible of recovery 
without resultant defect, is none the less a cause for rejection as long 
as it exists. 

130. Certain after effects of organic nervous disease need not be 
causes for rejection provided (1) that the disease is no longer opera¬ 
tive and is not likely to recur, (2) that the effect left by it does not 
prevent a satisfactory fulfillment of military duties. Examples of 
such conditions are paralysis of a few unimportant muscles following 
poliomyelitis, slight unilateral hypertonicity as a result of an infan¬ 
tile hemiplegia in a man now robust, and various traumatic condi¬ 
tions. 

XVII. LUNGS AND CHEST WALL. 

131. Registrants who on examination are found to present the fol¬ 
lowing conditions shall be unconditionally accepted for general 
military service: 

(a) Normal lungs. 

(h) Normal pleura. 

(c) Normal bronchi. 

(d) Acute bronchitis which is not tuberculous. 

(e) Hay fever. 


36 


(/) Scars of operation of empyema which have been healed for 
one year or longer when the function of the lung is good. 

(g) Acute pleurisy with effusion, provided the acceptance of the 
registrants shall be temporarily delayed for observation and re¬ 
examination and there has been established evidence satisfactory to 
the examiners that the pleurisy and the effusion have entirely disap¬ 
peared. 

(h) Fracture of the rib or ribs, provided the acceptance of the 
registrants is temporarily deferred until a final examination shows 
recovery with or without deformity, provided the deformity does 
not interfere with respiratory movement. 

(i) Benign tumors or hypertrophy of the breast, provided the 
enlargement does not interfere with the wearing of a uniform or 
military equipment. 

(j) Small, palpable lymph glands of the axilla which apparently 
do not interfere with the general health. 

(k) Syphilitic periostitis of rib or ribs, sternum or clavicle. 

132. Registrants who on examination are found to present the fol¬ 
lowing remediable defects, who are otherwise mentally and physically 
fit, may be conditionally accepted for general military service in the 
deferred remediable group: 

( a ) Typhoid periostitis of rib or ribs. 

(b) Tumor or hypertrophy of the breast with such enlargement 
of the breast as to interfere with the wearing of a uniform or mili¬ 
tary equipment. 

133. Registrants who on examination are found to present the fol¬ 
lowing defects shall be unconditionally rejected for all military service: 

(a) Tuberculosis of the lungs. 

(b) Tuberculous pleurisy. 

(c) Unhealed sinuses of the chest wall following operation for 
empyema. 

(cl) Chronic bronchitis with emphysema. 

(e) Chronic asthma associated with chronic bronchitis and em¬ 
physema. 

(/) Fetid bronchitis. 

(g) Bronchiectasis. 

(h) Syphilis of the lung. 

(i) Actinomycosis. 

(j) Hydatid cysts. 

(k) Restricted respiratory movements of chest due to deformity 
of the chest as a result of fracture of ribs or other injuries. 

(l) Tuberculosis of the ribs. 

(m) Cancer. 

134. When the Local Boards are in doubt concerning the physical con¬ 
dition of the registrants who present defects of the lungs, pleura or 
bronchi, they should be referred to the Medical Advisory Boards. 


37 


135. Inasmuch as pleurisy, with or without effusion, is a very fre¬ 
quent incidence of early tuberculosis, physicians of Local Boards and 
Medical Advisory Boards should examine with the greatest care registrants 
who have apparently recovered from pleurisy. 

136. The following information concerning methods of examina¬ 
tion of the lungs and the interpretation of the findings are pre¬ 
sented for the guidance of examiners. 

137. The examiners should be extremely careful to reject regis¬ 
trants with manifest pulmonary tuberculosis for all military service 
and to accept for military service registrants who allege tuberculosis 
as a ground for exemption or discharge on the basis of insufficient or 
incorrectly interpreted signs and symptoms. 

Men who desire to serve their country may conceal, from patriotic 
motives, symptoms of tuberculosis which they know or suspect to 
exist. Some tuberculous patients will seek enlistment with a view 
of obtaining treatment and a pension. Some soldiers who have 
volunteered may repent their action and allege symptoms of tuber¬ 
culosis with a view to securing discharge. Some registrants may be 
expected to claim the existence of tuberculosis as a ground for exemp¬ 
tion, and may fortify their claims by certificates of physicians and 
by radiographs. There will probably be many cases in which pul¬ 
monary tuberculosis will have been diagnosticated on the ground of 
subjective symptoms and of physical signs which are normal or 
indicate unimportant and healed lesions of some kind. 

It is necessary, therefore, that conclusions of the examiner shall 
be based only on physical signs, sputum examinations, and radio¬ 
graphs. Statements of the subject as to symptoms will not be 
accepted as proof of the existence of tuberculosis unless supported 
by objective evidence. 

It is the duty of examiners to protect the interests of the Govern¬ 
ment by preventing men from entering the service who have manifest 
tuberculosis. It is equally their duty to prevent the escape from 
service on the ground of tuberculosis of men who present slight or 
doubtful deviations from the normal. It is therefore necessary to 
insist that recommendations for discharge for tuberculosis of other¬ 
wise apparently healthy and vigorous men shall be based only upon 
the presence of definite and plainly marked signs of pulmonary le¬ 
sions. 

138. The following signs will not be regarded as evidence of 
pulmonary disease in the absence of other signs in the same portion 
of the lungs: 

(a) Slightly harsh breathing, slightly prolonged expiration over 
the right apex above the clavicle anteriorly and to the third dorsal 
vertebra posteriorly. The same signs at the extreme apex left side. 


38 


(b) Same signs second interspace right anteriorly near sternum 
(proximity of right main bronchus). 

( c ) Increased vocal resonance, slightly harsh breathing immedi¬ 
ately below center of left clavicle. 

(cl) Fine crepitations over sternum heard when stethoscope 
touches the edge of that bone. 

(e) Clicks heard during strong respiration or after cough in the 
vicinity of the sternocostal articulations. 

(/) The so-called atelectatic rales heard at the apex during the 
first inspiration which follows a deeper breath than usual or a 
cough. 

(g) Sounds resembling rales at base of lung (marginal sounds), 
especially marked in right axilla, limited to inspiration. 

(h) Similar sounds heard at apex of heart on cough (lingula). 

(i) Slightly prolonged expiration at left base posteriorly. 

(j) Very slight harshness of respiratory sounds with prolonged 
expiration in the lower paravertebral regions of both lungs posteri¬ 
orly, most marked at about angle of scapula, disappearing a short 
distance above that point, equal on both sides, or slightly more marked 
at the angle on one side, more frequently the left. 

139. The apices. —Incipient tuberculosis of the apex is often erro¬ 
neously diagnosticated. 

(< 2 ) On account of the misinterpretation of the normal sounds 
which are usually, slightly harsh breathing, slightly prolonged ex¬ 
piration over the right apex above the clavicle, anteriorly, and to 
the third dorsal vertebra, posteriorly. The same signs are usually 
found at the extreme apex of the left side. 

(b) Because the importance of minor differences between the two 
sides is exaggerated. It is safe to say that if given a sufficiently 
minute examination, there would be but few men who would fail 
to show some signs which might be interpreted as of pathological 
significance. 

(c) The truly incipient tuberculosis of the apex generally escapes 
detection when in an active state. When healed it constitutes the 
abortive tuberculosis of Bard. Induration of the apex has been 
described by Kronig as a nontuberculous affection. The important 
question here is whether the signs present indicate a healed or active 
process. They are harshness of respiratory sounds, prolongation of 
expiration, increased conduction of voice, and more or less dullness 
on percussion. These signs are caused by induration of pulmonary 
tissue. Induration caused by acute inflammation is relatively rare 
in tuberculosis. It is not characteristic of a recent but of an ad¬ 
vanced process, when present to an extent which permits detection 
by clinical methods. When it does occur, the subject is usually febrile 


39 


and evidently ill. In cases of ambulant subjects in apparently good 
health the presumption is that the above signs indicate an old, not 
an incipient lesion. The abortive tuberculosis of Bard and Kronig’s 
apical induration, whether or not it is due to an obsolete tubercu¬ 
losis, are not causes for rejection in the absence of tubercu¬ 
lous disease at a lower level in the upper lobe. Narrowing of 
Kronig’s isthmus is extremely common. It is not a sign of recent 
disease but of contraction of the lung from old disease. In considera¬ 
tion of the frequent asymmetry of the bony structures about the 
apices slight differences in the width of the isthmus on the two sides 
are unimportant. A distinct contraction of one side points to the 
existence of a tuberculous focus of the upper lobe: whether or not 
this focus is of clinical importance must be determined from the 
signs in the individual case. Contraction of the isthmus per se is 
not a cause for rejection. The attention of examiners is particularly 
invited to the necessity of exercising great conservatism in their 
interpretation of physical signs over the apices. Interpretation of 
such signs as indicating active tuberculosis would in many cases 
do the Government great injustice, leading to the exclusion of men 
who are fit for service. The only trustworthy sign of active apical 
tuberculosis is the presence of persistent moist rales. 

DIAGNOSIS OF TUBERCULOUS LESIONS IN GENERAL. 

140. The acute lesion. — If small, this lesion is manifested by rales 
with or without changes in breath sounds, percussion note, and voice 
transmission. The more acute the lesion the greater the probability 
that its presence will be indicated only by rales. If of large extent, 
the process is distinctly a broncho-pneumonia, generally caseous, 
characterized at first by the usual signs of pneumonia, crepitant, 
and subcrepitant rales; when caseated, by absence of rales, except 
coarse and distant rales from the larger bronchi, also by impair¬ 
ment of expansibility of the lung, and more or less dullness or tym¬ 
panitic resonance; when breaking down, by cavity signs and the 
presence of loud moist rales of varying size. Large acute lesions are 
rarely found in candidates for enlistment, and the small acute lesion 
is also comparatively rare. 

141. The arrested chronic lesion .—It is by no means rarely the 
case that a tuberculous lesion will run its course and become arrested 
without the knowledge of the subject, who may state in perfectly 
good faith that he has never had tuberculosis. The arrest of a lesion 
is indicated by the absence of rales. Such a lesion is characterized by 
harshness of breath sounds and prolongation of expiration, by in¬ 
creased vocal fremitus and resonance, and by more or less pronounced 
dullness on percussion. 


40 


142. The active , chronic , localized lesion .—Activity is denoted by 
the presence of rales, together with the other signs described under 
the arrested lesion. Rales do not necessarily show that the lesion is 
extending nor that the activity is of much clinical importance, but 
in military practice the presence of rales accompanied by breath 
changes and other signs should be an indication for rejection. The 
more active and recent the chronic lesion the less marked the breath 
changes and the more conspicuous the rales. 

143. Disseminated tuberculosis .—True miliary tuberculosis is not 
likety to come to the attention of the military examiner. The peri¬ 
bronchial type is common and frequently not recognized. In the 
adolescent the peribronchial tuberculosis may be extending from the 
deep lung without as yet developing a superficial focus. It may be 
manifested only by the presence of distant rales with or without 
slight changes in the breath sounds which are of slight bronchovesic- 
ular quality. If the case is well marked, there will be impairment 
of expansibility of the affected side and increased vocal resonance. 
Less pronounced cases are distinguished from chronic bronchitis 
only by the character of the rales (coarser in bronchitis) and by their 
topical distribution. 

144. More frequently the peribronchial type is found accompany¬ 
ing a superficial focus. Broncho-vesicular breathing may extend 
some distance below the limits of the superficial focus with or with¬ 
out rales. But the most important manifestation of the peribron¬ 
chial type is extension to the formerly sound side. There may be a 
small, obscure, apparently arrested lesion of one side, usually the 
right, with a peribronchial extension involving the whole or the 
greater part of the other lung manifested only by the presence of 
rales after expiration and cough. 

145. A definitely demonstrated tuberculosis lesion of more than 
insignificant size below the apex is cause for rejection whether such 
lesion be active or inactive. 

146. The method of “ expiration and cough .”—In ambulant afebrile 
subjects harshness of breath sounds and prolongation of expiration 
characterize the old and relatively dry lesion, while the more acute 
the process the less marked are the breath changes and the greater 
are the conspicuousness and significance of rales. No examination 
for tuberculosis is complete without auscultation following a cough. 

147. It is best executed as follows: Starting from the state of rest 
of the lung the subject forcibly expels the air from the lungs, reserv¬ 
ing the last portion of the expiration for a short cough, after which 
inspiration immediately follows, but only enough air is inhaled 
to return the lung to the state of rest. The idea is to diminish the 
size of the bronchi as much as may be by expiration, then to cough 


41 


to stir up forcibly such fluid as may be present in them. The mois¬ 
ture is more likely to be moved by the current of air and so produce 
rales when the tubes are of their least caliber. This procedure 
should invariably be employed in examinations in order to deter¬ 
mine the activity of lesions found by other signs and also to detect 
the existence of fresh disseminated tuberculosis. 

148. Examination of sputum .—The presence of tubercle bacilli in 
the sputum is a cause for rejection. Examiners should, however, 
take pains to convince themselves that the sputum examined came 
from the lungs of the person under examination. To this end they 
should insist that the sputum be coughed up in their presence or in 
that of the pathologist who makes the miscroscopical examination. 

149. Tuberculin .—It is well rocognized that a positive reaction to 
tuberculin, especially in the young adult, is not a proof of the pres¬ 
ence of active clinically important tuberculosis. Tuberculin only 
demonstrates activity of the tuberculous process in the clinical sense 
when it can be shown to produce a focal reaction. Such reaction 
is not without danger. Since, therefore, tuberculin rarely leads to 
a correct diagnosis and may do injury, its general use in the diag¬ 
nosis of tuberculosis in examinations for enlistment is prohibited. 

150. X ray .—Only well-marked pathological changes are revealed 
by radioscopy. For the accurate diagnosis of tuberculosis re¬ 
course should always be had to the study of the X-ray negative. It 
is not of course practicable always to use radiography extensively 
for the determination of tuberculosis during the examination of 
registrants. But the X ray will doubtless be often employed in 
doubtful or disputed cases, so that it is necessary to consider the rules 
which should obtain in reading the radiograph. 

Morbid changes in the lungs are shown by shadows due to two sub¬ 
stances, first, blood; second, fully* organized connective tissue. 
Blood imprints a shadow on the negative only when present in abun¬ 
dance. The congestion of lobar pneumonia is typical. Broncho¬ 
pneumonia of tuberculous origin may also cast shadows, but only 
when the process is acute, the congestion great. Frequently the tuber¬ 
culous process runs so chronic a course that the inflammatory reac¬ 
tion is insufficient to congest the lung enough to produce a shadow. 
The shadow of congestion is not sharply outlined; it melts away at 
its borders. 

Connective tissue in the parenchyma of the lung away from the 
hilus is not normally present in sufficient quantity to retard appre¬ 
ciably the passage of the X rays except as it occurs in connection 
with and as a part of the various tubes, bronchi, blood vessels, and ' 
lymphatics. As a result of proliferative inflammation connective tis¬ 
sue develops as a fibrous thickening of these tubes, particularly the 


42 


bronchi and the lymph vessels, which casts a shadow deeper than 
normal; the older the process and the better organized the tissue, the 
denser the shadow and the sharper its outline. Tubercle, caseations, 
as such, cast no shadows distinguishable from the other tissues of 
the parenchyma. It has been found that cubes, 1 cubic centimeter in 
size, of caseous tubercle when embedded in a healthy lung are indis¬ 
tinguishable by the X ray. But if the caseations become calcified or 
are even impregnated abundantly with mineral salts they become 
opaque to the X ray. In general, and especially if one has to do with 
the shadows of tubes, it may be said that fuzziness of outline means 
acute vascular congestion, an active process. On the other hand, 
when the shadows of the tubes are sharp we have a process which, 
if active at all, is at least not characterized by great acuity, is not con¬ 
gestive. There is what is called dry tuberculosis of the lung tissue, 
which inclines to abundant formation of connective tissue, to dry 
caseations and cicatrizations, or to complete transformation into 
fibrous tissue, characterized by sharply outlined granular spots and 
by more or less sharply marked bands and streaks. Special attention 
is called to the persistence of the sharply outlined dots and lines 
when activity of the tuberculous process no longer exists. The 
sharply outlined thickenings of the bronchi and other tubes may be 
evidence of an old inflammation now entirely obsolete, may be sim¬ 
ply records of the ancient history of the pulmonary tuberculosis. 

We do not see tubercles in the X-ray negatives. What we see are 
either sharply outlined calcifications and fibroses, or fuzzy conges¬ 
tions, or a combination of the two conditions. Cases are seen in 
which the X ray in general gives the same findings in both lungs, 
while the autopsy proves one lung severely, the other slightly, dis¬ 
eased. Such cases illustrate well the limitations of X-ray diagnosis. 
What is seen in the X-ray negative is the thickened framework of old 
inflammation in the two lungs, in one accompanied by much paren¬ 
chymatous disease of recent origin, in the other accompanied by 
little, the said parenchymatous disease being invisible to the X ray 
because neither sufficiently congested nor sufficiently organized to 
cast shadows. 

In view of these facts the data obtained by study of the physical 
signs will as a rule govern in the forming of the diagnosis. The 
diagnosis of active tuberculosis should not be made from the X ray 
if not corroborated by physical signs. 

Extensive systems of lines, many sharply outlined spots, or dense 
streaks do not, then, show an acute process. 

Persons in good health with nearly or quite arrested tuberculosis 
are sometimes found by the X ray to present a picture of very ex¬ 
tensive changes of this kind. Yet the prognosis in such cases is not 


43 


good if the subjects be subjected to severe strain. The radiograph 
is a proof that the lungs have undergone serious changes. The dan¬ 
ger is either that hardship will lead to a reactivation of the numerous 
more or less quiescent tuberculous lesions or, if the process has been 
largely of the nature of fibrosis, that the lungs have been so damaged 
thereby as to unfit the person for an active life. If, then, the radio¬ 
graph shows extensive dappled or mossy shadows or numerous spots 
and streaks the recruit should be rejected, however good his health 
may appear to be. Shadows of a homogeneous opacity result from 
pleurisy and are not necessarily a cause for rejection in the absence 
of other signs. 

Tuberculosis of the bronchial glands is a diagnosis often made 
from the radiograph on very slight foundation. The facts are that 
pronounced swelling of the lymph glands is characteristic of pri¬ 
mary, not of advanced, tuberculosis. It is rare that intrathoracic 
gland tuberculosis is of any clinical importance in the adult. With 
few exceptions cases of bronchial gland tuberculosis which lead to 
true symptoms of disease are confined to the first and second years of 
life. Onl}' rarely, especially in adults, is so-called hilus gland tuber¬ 
culosis a purely glandular process; it is rather a more or less pro¬ 
nounced disease of the surrounding hilus tissue in the form of- peri¬ 
bronchial and infiltrative processes of the neighboring pulmonary 
tissues. That is, the interscapular dullness relied upon for the diag¬ 
nosis of enlarged glands, if caused by lung conditions, is due to 
tuberculous processes in the region of the hilus, participation in 
which to any important extent on the part of the glands is a matter 
of conjecture. The presence of masses in the neighborhood of the 
hilus as shown by the X ray may indeed be cause for rejection, but 
rejection on account of relatively small opacities in that region on 
the ground that they indicate a bronchial gland tuberculosis of clini¬ 
cal importance certainly should not be permitted. 

151. Resume of indications from X-ray negatives .—The X ray 
shows (1) tuberculous disease confined to region of hilus in deep 
lung; (2) extension upward toward apex or downward and out¬ 
ward toward base, confined to deep lung; (3) a fine line or two 
extending to apex with or without small focus or foci there— 
condition not determinable by physical signs; (4) clouding of apex 
without marked lines from hilus, probably largely pleuritic; (5) 
well-marked lines extending to superficies of apex, usually, but 
not necessarily, with foci there—lesion accessible to physical ex¬ 
amination; (6) lines extending toward shoulder as well as apex— 
(a) if confined to deep lung may mean early and now obsolete 
exacerbation— (b) if extending to superficies denote larger lesion 
and less immunity than 5; (7) more or less widely diffused spots, 


44 


lines, and streaks through a considerable portion of lower lobe ap¬ 
proaching periphery of lung, with few or no auscultatory signs—• 
deep peribronchial tuberculosis; (8) more extensive streaked opaci¬ 
ties involving greater part of one or both lungs and extending to pe¬ 
riphery with few or many physical signs—fibrocaseous tuberculosis, 
fibrosis preponderating in proportion to scantiness of more or less 
rounded spots or dots. 

Conditions as shown by 1, 2, 3, 4, and 6 ( a ) are not causes for 
rejection. Cases under 5 are to be determined by physical exami¬ 
nation. Cases under 6 (b), 7, and 8 are to be rejected. 

XVIII. HEART AND BLOOD VESSELS. 

152. The following procedure should govern in the examination 
of the heart: 

(a) Location and determination of character of apex impulse. 

(b) Auscultation of the heart sounds over apex, lower sternum, 
and second and third interspaces to right and left of sternum, 
noting accentuation of sounds and murmurs. 

( c) Inspection of root of neck and upper thorax and percussion 
of first interspace on each side of manubrium for evidence of 
aneurysm. 

( d) Count of radial pulse, observation of its rhythm, and palpa¬ 
tion of radial arteries for unusual thickening or high tension. 

( e ) Exercise test: Hopping 100 times on one foot. At close 
count heart rate with stethoscope over apex, listening for murmurs 
and noting how long tachycardia and unusual dyspnoea persist. 
After two minutes neither should be marked. Examiners should 
use judgment and discretion in applying the exercise test to regis¬ 
trants who, in the preliminary examination, present evidence of 
incompetency of the heart. Registrants should not be placed in 
jeopardy, but at the same time the exercise test is an important factor 
in determining the condition of the heart. 

153. Registrants who on examination show the following condi¬ 
tions, who are otherwise mentally and physically fit, shall be uncon¬ 
ditionally accepted for general military service : 

(a) Normal heart. (A heart shall be considered normal when 
the apex impulse is within the left nipple line and not below the fifth 
interspace, not heaving in character, with normal sounds, free from 
murmurs, absence of pulsation or dullness above the base of the 
heart, regular pulse of normal rate, no unusual thickening of the 
arteries or evidence of high blood pressure, and a normal response to 
the exercise test.) 

(b) A pulse rate of 100 or over which is not persistent. (A pulse 
rate of 100 or over may be temporary and due to a recent infection 


45 


such as typhoid fever or local infections about the nose, mouth, and 
throat.) 

(c) A pulse rate of 50 or under which is proved to be the natural 
pulse rate of the registrant or to be temporary or due to the use of 
drugs. 

(cl) Sinus irregularity. (This consists in a quickening of the 
pulse rate during inspiration and a slowing during expiration and is 
best recognized with the registrant recumbent and breathing deeply.) 

( e ) Old thrombophlebitis of one extremity unassociated with any 
evidence of persistence of the cause thereof or of obstruction in the 
involved vein or veins. 

154. Registrants who on examination are found to present the fol¬ 
lowing defects shall be unconditionally rejected for all military service: 

(a) Circulatory failure evidenced by definite symptoms such as a 
combination of breathlessness, marked cyanosis or edema. 

(b) Hypertrophy and dilation of the heart evidenced by displace¬ 
ment of the apex impulse to the left of the nipple line or below the 
sixth rib, and of a heaving or diffuse character. 

( c ) A persistent heart rate of 100 or over when this is proved to be 
persistent in the recumbent posture and on observation and re¬ 
examination over a sufficient period of time. 

(d) A persistent pulse rate of 50 or under proved to be due to 
heart block. 

( e ) Complete irregularity of the pulse when this is found to be 
due to auricular fibrillation. 

(/) Valvular disease, as evidenced by characteristic murmurs, en¬ 
largement of the heart, and a lack of the normal response to exercise. 

(g) Arteriosclerosis and hypertension evidenced by a tense pulse, 
persistent systolic blood pressure above 100 m. m., accentuation of the 
aortic second sound when the registrant is in quiet recumbency. 

(h) Intermittent claudication associated with a diminution or ab¬ 
sence of pulsation of the blood vessels about the ankle and foot. 

(i) Raynaud’s disease. 

(j) Erythromelalgia. 

(k) Thrombophlebitis of one or more extremities if there is a 
persistence of the thrombus or any evidence of obstruction of circu¬ 
lation of the involved vein or veins. 

(l) Aneurysm of the arch of the aorta or of any other large vessel. 

155. When Local Boards are in donbt concerning the physical fitness 
of registrants who suffer from defects due to conditions of the heart or 
blood vessels, they shall refer them to the Medical Advisory Boards. 

156. It is incumbent upon Local Boards, Medical Advisory Boards, 
and medical officers of the Army: 

(a) To accept for service men who have been recommended for 
rejection because of supposed defects which do not indicate disease 


46 


and do not impair the individual’s ability to undergo severe bodily 
exertion. 

(b) To exclude from active service in the Army any registrant 
affected with disease of the heart or blood vessels which impairs his 
ability to undergo severe bodily exertion. 

157. Men who desire to serve their country may from patriotic 
motives endeavor to conceal a known valvular lesion which has given 
no symptoms. On the other hand, men drafted for service may al¬ 
lege or feign symptoms to obtain exemption. Registrants may be 
expected to present physicians’ certificates to substantiate the ex¬ 
istence of valvular disease. Many of these may be given in good 
faith, because of inadequate knowledge of the significance of certain 
frequent murmurs. 

158. It is necessary, therefore, that the conclusions of the examiner 
shall be based on objective evidence in the widest sense, including 
both physical signs, cardiac rhythm, measurement of the blood pres¬ 
sure, and the observed effect of effort. Nevertheless, in the presence 
of questionable signs or symptoms, the history, especially of past 
rheumatic fever, may be a factor in the final decision. No statements 
of the subject, however, will be accepted as proof of the existence 
of a cardio-vascular defect, unless supported by objective evidence. 

159. Since it is the duty of examiners to protect the interests of 
the Government by preventing men from entering the service whose 
circulatory systems may be expected to break down under strain, 
and equally by preventing the exemption or discharge of fit subjects 
because of unimportant deviations from the normal, it will be neces¬ 
sary for them to exercise every care in the interpretation of their 
findings and to bear in mind constantly tfie murmurs and other de¬ 
partures from the supposed normal which may occur in perfectly 
healthy hearts. 

160. Principles of interpretation of symptoms and signs referable 
to the heart. —The following principles are laid down for the guid¬ 
ance of examiners in their interpretation of abnormal signs and 
systoms: In many cases the interpretation must be purely individual 
and based on the cumulative evidence of a number of relatively 
slight deviations from the normal. It can not be too strongly 
insisted on that, given a heart of normal size and responding nor¬ 
mally to effort, any murmur that is heard should be considered ac¬ 
cidental and insignificant unless it can be positively demonstrated 
that it is a mitral or aortic diastolic murmur. It should also be 
constantly borne in mind that the excitement of the examination 
may produce violent and rapid heart action, often associated with 
a transient systolic murmur, which conditions may erroneously be 
attributed to the effects of exertion. They will usually disappear 
promptly in the recumbent posture, but the examiner must be 


47 


shrewd to distinguish the excitable individuals and take measures to 
eliminate psychic influences from the test so far as possible. 

161. Hypertrophy and dilatation of the heart. —Impulse to the 
left of the nipple line or below the sixth rib and of heaving char¬ 
acter is cause for rejection. Its cause, either valvular disease or 
hypertension in the majority of cases, should be sought for. It 
should not be made a primary diagnosis unless careful examination 
fails to reveal a cause. 

162. Valvular diseases. —Cardiac murmurs are the most certain 
physical signs by which valvular disease may be recognized and 
its location determined, but murmurs are very frequent in the ab¬ 
sence of valvular lesions and may occur in perfectly healthy hearts, 
especially under the influence of excitement and exertion. Such 
accidental murmurs are always systolic in time. The most fre¬ 
quent of these are: 

(а) Those heard at the apex on excitement, especially when recum¬ 
bent. 

(б) Those heard over the second and third left interspaces during 
expiration, disappearing during forced inspiration. These are par¬ 
ticularly common in men with flexible chests, who can produce 
extreme forced expiration and under such circumstances may be 
associated with definite thrill. 

( c) Systolic accentuation of the respiratory murmur, especially 
on inspiration, heard near the apex or over the back. 

Systolic murmurs as described in subparagraphs ( a ), (ft), and ( c) 
are not indicative of defects which shall disqualify a registrant for 
general military service. 

Systolic murmurs unassociated with enlargement of the heart, 
alteration of the first sound, accentuation of the pulmonic second 
sound, or abnormal response to exercise may also be considered as 
without significance. 

163. Other systolic murmurs: 

(a) Loud systolic murmurs, audible at the apex and in the left 
back, if associated with any enlargement of the heart, with snapping 
first sound, or accentuation of the pulmonic second sound, constitute 
a disqualifying defect. (See (/), Par. 154.) 

(h) Systolic murmurs at the base, except as specified above, 
especially those heard in the second right intercostal space, require 
more careful scrutiny. They may be due to disease of the aortic 
valves. In this case they should be harsh, conveyed well into the 
neck, associated with an aortic diastolic murmur, with thrill, or 
with a marked enfeeblement of the aortic second sound. They 
are more often due to dilatation of the aorta, either syphilitic or 
arteriosclerotic. The other signs of dilatation should then be 
sought—increased dullness in the first and second interspaces to 


48 


either side of the manubrium, pulsation in this area, accentuation 
of the aortic second sound. In doubtful cases X-ray examination 
and Wassermann test should be made. 

164. All diastolic murmurs, at apex or base, including presystolic 
murmurs, shall be considered evidence of valvular disease. The 
secondary signs should be sought for, viz, enlargement of one or 
both sides of the heart, alteration of the first or second sound, par¬ 
ticular^ a snapping first sound and accentuated pulmonic second 
sound in mitral disease, and the characteristic pulse of aortic insuffi¬ 
ciency. In doubtful cases a definite history of rheumatic fever may 
be given weight. The exact diagnosis should be noted on the record. 

165. It should be borne in mind that the characteristic presytolic 
murmur in certain cases of mitral stenosis may not be audible during 
rest. It is therefore important, in every doubtful case, that ausculta¬ 
tion be made immediately after the exercise test and in both the erect 
and the recumbent positions. On the other hand, many cases of tachy¬ 
cardia or overacting heart present physical signs very suggestive of 
mitral stenosis (sharp, tapping apex beat, sharp, loud first sound, 
suggestion of apical thrill, etc.), and the diagnosis of mitral stenosis 
should not be made unless a distinct presystolic or diastolic murmur 
is heard. 

XIX. GENERAL. 

166. Registrants who on examination are found to present the fol¬ 
lowing condition who are otherwise mentally and physically fit shall 
be unconditionally accepted for general military service: 

(a) Malaria, acute or chronic. 

167. Registrants who on examination are found to present the fol¬ 
lowing remediable defects who are otherwise mentally and physically 
fit may be conditionally accepted for general military service in the 
deferred remediable group: 

(a) Secondary anemia, due to hemorrhoids or any other remedi¬ 
able cause. 

(b) Debility due to recent illness or to employment or environment 
in civil life. 

168. Registrants who on examination are found to suffer from the 
following defects shall be unconditionally rejected for all military 
service: 

(a) Pellagra. 

(b) Leucemia of all clinical types. 

( c ) Progressive pernicious anemia. 

(d) Splenic anemia. 

(e) Hemophilia. 

(}) Cancer. 

( g ) Tuberculosis. 

( h) Irremediable metallic poisoning. 


49 


169. Registrants who are confined from injury or illness to their 
homes, hospitals, or other institutions for the care of the sick shall be 
examined and dealt with for the conditions or defects found, as indicated 
in Chapters III to XXI, inclusive. 

XX. TEMPORARY DEFECTS. 

170. Registrants who are confined from injury or illness to their 
homes or hospitals or other institutions for the care of the sick and 
are found to suffer from temporary defects should be granted a rea¬ 
sonable delay for the purpose of completing the physical exami¬ 
nation. 

171. Registrants who are reported to the Local Boards or to the Medi¬ 
cal Advisory Boards to be confined to their homes or to hospitals or in¬ 
stitutions for the care of the sick because of contagious, communicable, or 
reportable diseases, should not be ordered to appear before Local Boards 
or Medical Advisory Boards until they shall have been discharged by 
health authorities having jurisdiction. 

172. Registrants who are convalescent from diphtheria should not be 
inducted into military service until two negative cultures in succession 
shall have been obtained from the throat. 

173. When Local Boards or Medical Advisory Boards are unable to 
command the facilities for making throat cultures of registrants recover¬ 
ing from diphtheria, the cultures may be sent by mail to the laboratories 
of the United States Public Health Service. When it is possible to do 
so, municipal and State health laboratories should be utilized in the same 
way. 

XXI. NOTES ON MALINGERING. 

174. Malingerers may be divided into three general groups: 

(a) Real malingerers with nothing the matter with them, who 
injure themselves, or make allegations respecting diseases or such 
conditions as drug taking, or who counterfeit disease with full 
consciousness and responsibility; all for the purpose of evading 
military service. Many of these have been coached. 

(b) Psychoneurotics, who are natural complainers and try to get 
out of every disagreeable thing in life. Perhaps only partially 
conscious of the nature or the seriousness of what they do and only 
partly responsible. In many the motives are not persistent and 
many can be made into good soldiers. 

( c ) Confirmed psychoneurotics with long history of nervous 
breakdowns and illnesses who behave like class ( a ), but more per¬ 
sistently, and from whom not much can be expected in the way of 
reconstruction. 


50 


175. The detection and management of medical cases depends upon 
the absence of positive findings in one who presents the general char¬ 
acteristics of the malingerer. There is especial need for the physical 
examination to be thorough in this group. Some of the cardiac cases 
at first regarded as malingerers were pronounced later by the cardio¬ 
vascular board to have mitral stenosis, and similarly proper tests 
have shown the existence of gastric ulcer in cases which were under 
suspicion of fraud. The estimation of the reality of rheumatic pains 
is always a difficult matter. 

176. Surgical .—Under this are included old scars and injuries of 
the bones, fractures, and orthopedic conditions. 

Note. —For the detection of malingerers, in tests of vision and hearing, see 
paragraphs 26 to 33, inclusive, 39, and 40. 

177. Artificially created conditions .—Men shoot or cut off their fin¬ 
gers or toes, practically always on the right side, to disqualify them¬ 
selves for service. Sometimes they put their hands under cars for this 
purpose. Many men have their teeth pulled out. Retention of urine 
is simulated. Egg albumen is injected into the bladder or put in 
urine. Glucose is added to urine. Digitalis, thyroid gland prepara¬ 
tions, and strophanthus are taken to cause disturbance of the heart and 
cantharides to cause albuminuria. The skin is irritated by various 
substances, which are also injected under it to create abscesses. 
Various substances are taken to bring about purging. An appear¬ 
ance of hemoptysis may be produced by adding blood, either human 
or that of animals, to the sputa. Sometimes merely coloring mat¬ 
ter is added. Those who can vomit voluntarily what they swal¬ 
low use the same means to create the appearance of liematemesis. 
Similarly coloring matters may be added to the stools. Mechanical 
and chemical irritants are made use of to cause inflammation about 
practically all the body orifices. Jaundice may be simulated by 
taking picric acid. Crutches, spectacles, trusses, strappings, etc., are 
made use of to create the appearance of disability. 

178. Detection .—Wounds are rarely self-inflicted when witnesses 
are present, consequently it is almost impossible to be certain of the 
motive behind these. Artificial jaundice is to be recognized by the 
demonstration of picric acid in the urine. 

179. Bed wetting .—A frequent complaint among registrants for 
military service but not a cause for rejection. 

180. The surest means of detecting malingering is a thorough under¬ 
standing by the examiner of the types of people who actually do it— 
and the way they behave. It is only in the feigned diseases of the 
eye and ear that special tests are required. Observation in hospital 
is necessary in difficult cases. The vast bulk of malingerers are those 
who exaggerate some actual defect, and the problem for the medical 


51 


examiner is to decide whether the defect complained of is sufficient 
cause for rejection for service. Persons of intelligence and educa¬ 
tion have more difficulty in deceiving, as they are bound to express 
themselves freely. If they are reticent in these matters they arouse 
suspicion by their reticence. Those who talk freely may be counted 
on to say things at variance with the existence of the disease of 
which they complain. 

IMPORTANT NOTE.—Concerning action to be taken in cases of self- 
mutilation, or defects resulting from self-inflicted or purposely inflicted 
injuries, see note to section 128^ (page 62, herein). 

NERVOUS AND MENTAL. 

181. Insanity. —Rarely feigned by registrants and then of an ex¬ 
tremely silly, foolish type. In cases of doubt, hospital observation is 
necessary with verified past records. Mental defects are frequently 
feigned, especially by illiterates. Organic diseases of the central 
nervous system can not be simulated. 

182. Pain and hyperesthesia. —The most frequent of all complaints. 
History inconsistent, ordinary traces of suffering absent. Absence of 
other symptoms usually accompanying types of pain complained of. 
Absence of objective evidence of localized pains. Note behavior 
when the registrant believes himself unobserved. 

183. Anesthesia. —Complaint of anesthesia itself creates a sus¬ 
picion of malingering, as most patients with anesthesia are ignorant 
of it. 

184. Epilepsy. —Men who have sustained head injury are very apt 
to claim fits. These complaints may be in reference to grand mal or 
petit mal. Petit mal attacks are spoken of as fainting attacks. In 
grand mal attacks there is loss of pupil response to light, knee jerks 
are lost, and the Babinsky reflex may be present. 

185. Hysteria. —Not feigned in itself, but its existence creates con¬ 
fusion as to malingering. The question to be decided is whether the 
registrant is too seriously affected with the neurosis to be useful as a 
soldier. Often, even when the physical symptoms are most pro¬ 
nounced (paralysis), cure is still possible. 

186. Stiff lacks. —Stiff back is a frequent symptom of hysteria in 
the present mobilization among selected men. In cases of this kind 
organic disease of the vertebra} can and should be excluded, if neces¬ 
sary, by the X ray. 


APPENDIX. 


IMPORTANT SECTIONS OF THE SELECTIVE SERVICE 
REGULATIONS AND RULES OF PROCEDURE RELATING 
TO PHYSICAL EXAMINATIONS, AND PERTAINING TO 
MEDICAL EXAMINERS AND LOCAL, DISTRICT, AND 
MEDICAL ADVISORY BOARDS. 


Section 25, S. S. It. Correspondence rules of the Office of the Provost 
Marshal General. 

Rule A. Except as specifically provided in these Regulations, all 
communications intended for the Provost Marshal General concern¬ 
ing the execution of the selective service law within a State emanat¬ 
ing from individuals within the State or from Local and District 
Boards or other officials engaged within any State in the execution 
of the selective service law must be directed to the Adjutant General of 
the State for reference to the Provost Marshal General. Correspondence 
sent in violation of this rule to the Office of the Provost Marshal 
General will be returned to the writer. * * * 

Section 20, S. S. R. Governor to district State and appoint Medical 
Advisory Boards. 

Each State shall be carefully districted with due regard to com¬ 
munication and hospital facilities for the erection of a number of 
Medical Advisory Boards computed with a view to the equitable and 
practical distribution of the work of reexamination as provided 
herein and to the convenience of registrants and economy to the 
Government in sending registrants before such boards. 

To assist the governor in this work a member of the Officers’ 
Reserve Corps of the Medical Department will be ordered to active 
duty to report to the governor for a sufficient time to accomplish 
this organization. The American Medical Association and the medi¬ 
cal section of the Council of National Defense have also offered their 
services to governors in accomplishing this purpose. Members of 
medical advisory boards will be nominated by the governor and 
appointed by the President in accordance with instructions to be. 
hereafter communicated to the governors. 

(52) 




53 


Note 1.—Medical Advisory Boards' in each State should be designated by 
numbers (consecutively, with no use of a general number and letters for 
divisions of counties and cities). Each Board should be notified of the number 
assigned it and should be required to use this number designation on all 
vouchers and receipts sent to the Office of the Provost Marshal General. (See 
circular letter Provost Marshal General’s Office to Draft Executives, Apr. 18, 
1918, in re Medical Advisory Boards.) 

Note 2.—Appointments to and removals from Medical Advisory Boards can 
not be made without reference to the President through the Office of the 
Provost Marshal General. The Regulations require members of said Boards 
to be nominated by the ’governor and appointed by the President. (See 
circular letter, Provost Marshal GeneraFs Office, to Draft Executives, Apr. 18, 
1918, in re Medical Advisory Boards.) 

Note 3.—The medical aide to the governor should be the instrument of 
direct communication between the governor or his adjutant general and the 
Local Boards and Medical Advisory Boards in all matters concerning questions 
relating to that part of the Selective Service Regulations which pertains to the 
physical examination of registrants. (For information relating to powers and 
duties of medical aides, see circular letter, Provost Marshal GeneraFs Office, to 
Draft Executives, May 8, 1918, in re medical aides.) 

Section 38, S. S. R. Organization and procedural rules of Local Boards. 

Members of Local Boards shall take the oath prescribed in section 
14 of these regulations. 

A majority of each Local Board shall constitute a quorum for the 
transaction of business, and, except as provided in section 101, Rule 
XXVIII, and in section 123, a majority of those present at any 
meeting may decide any question before such board for decision. If, 
in the case of a board consisting of three members, any two members 
are unable to agree, the matter upon which they disagree shall be 
submitted to the board when all three members are present. 

The board shall choose one of its members to be chairman and one 
to be secretary. If one member of the board is a licensed physician, 
he shall act as examining physician of the board. (See sec. 196.) 

Local Boards may make rules of procedure not inconsistent with 
the selective-service law or with these Rules and Regulations. 

For clerical organization of Local Boards, see sec. 43. 

Note. —The question of physical qualification is to be decided by vote as any 
other question. 

Section 42 (S. S. R,). Additional examining physicians. 

In addition to the licensed physician who is a member of the board 
or if no licensed physician is a member of the board, the governor 
or the Local Board shall designate and appoint additional examining 
physicians, subject to removal by the governor at his pleasure, one, 
if the number of persons to be examined in any one day shall exceed 
30; two, if the number of persons to be examined in one day shall 
exceed 60; three, if the number of persons to be examined in one day 
shall exceed 90, and others in like ratio. 


54 


It shall be the duty of persons thus designated to act as examining 
physicians of the Local Board for which they are designated, and 
they may be compensated at rates hereinafter prescribed. In addi¬ 
tion to the number of physicians that may be thus designated and 
compensated under the above authority, volunteer physicians in any 
convenient number may be utilized for the examination of regis¬ 
trants upon appointment as aforesaid. 

Examining physicians (unless actually appointed by the President 
as members of boards) are not to be considered as members of such 
boards. They should take the oath prescribed in section 14 of these 
regulations. They shall have no vote on any question to be decided 
by said board. Their report on the physical examination of a regis¬ 
trant is advisory only. 

Note. —The services of volunteer dentists to aid in physical examination of 
registrants by Local Boards may be utilized, but they are not members of Local 
Boards and have no vote. 

Section 43, S. S. R. Clerical assistance for State headquarters and for 
District, Local, and Medical Advisory Boards. 

When authorized by the governor as prescribed in section 198 
hereof, there may be engaged and compensated at the rates of pay 
prescribed in this section clerical assitance as follow's: 

•*' V 'I' V 5*' V v 

(d) For Medical Advisory Boards: 

1. One' chief clerk. 

2. One additional clerk. 

The rate of compensation for a* chief clerk shall not exceed the 
rate paid for similar service under local law, in no case to exceed 
$100 per month. 

The rate of compensation for additional clerks shall not exceed 
the rate paid for similar service under local law, in no case to 
exceed, for not more than one additional clerk of any District, Local, 
or Medical Advisory Board $80 per month; for all other clerks in 
addition to the chief clerk and one additional clerk, $60 per month. 
Section 44, S. S. R. Medical Advisory Boards. 

There have been provided in the various counties, cities, and other 
localities throughout the United States Medical Advisory Boards, 
who will examine registrants sent to them by Local Boards or State 
Adjutants General for examination, and will advise such Local Boards 
or State Adjutants General concerning the physical condition of such 
registrants. Upon the advice so obtained, Local Boards may proceed 
to a final determination concerning the physical qualifications of such 
registrants. 


Note 1.—The personnel of the Medical Advisory Boards should be kept at all 
times as full as efficiency demands. Members of these Boards who hold com¬ 
missions in the Medical Reserve Corps, when assigned by the Surgeon General 
to active duty, automatically cease to be members of the Boards. Vacancies 
on the Boards thus created may be filled as provided in section 29 of the 
Selective Service Regulations. 

Note 2.—In those States and localities where it is impossible to organize an 
Advisory Board with a complete personnel of qualified specialists it is not ex¬ 
pected that the Advisory Board will be able to carry out the complete directions 
for the physical examination of those registrants who require it. In this emer¬ 
gency the medical aid to the governor, with the latter’s authorization, should 
make provision, if possible, for the registrant to be examined by competent 
specialists who may not be members of Advisory Boards, or recommend that 
such registrants be accepted by the Local Board and sent to the cantonment 
for reexamination. The Advisory Board should examine registrants at the 
established headquarters of the Board, which by preference should be a general 
hospital. In certain emergencies the registrant may be sent elsewhere for 
special examination, such as taking a roentgenogram, eye and ear tests, etc. 

Note 3.—A dentist should be appointed as a member of every Medical Ad¬ 
visory Board wherever possible. Membership of Medical Advisory Boards is not 
limited as to number and dentists may be added to boards already appointed. 
(Telegram No. A 189.) 

Note 4. — Men of military age may serve as associate members of Medical Ad¬ 
visory Boards at any time prior to induction into military service. (Telegram 
No. A 2070.) 

Section 46, S. S. K. Duties of lawyers and physicians generally. 

The selection and classification of men for military service is an 
undertaking that should be regarded as a systematized effort of the 
citizenry of the whole Nation organized and compacted to meet the 
present emergency. Every citizen has a duty to give his best endeavor 
to the success of this undertaking according to his qualifications and 
talents. All la'wyers and physicians should regard it as their duty 
to identify themselves with the Advisory Boards provided for in 
sections 44 and 45, and freely and without compensation to give their 
best service to the Nation. It is inconsistent with this duty for 
lawyers to seek clients for the purpose of urging and advocating indi¬ 
vidual cases in any other way than as disinterested and impartial 
assistants of the selective service system. 

Physicians will render a most valuable assistance by giving their 
services to Local Boards and to the Medical Advisory Boards pro¬ 
vided in section 44 hereof. 

Section 122, S. S. R. Physical examination. 

Beginning on such date or dates as the Provost Marshal General 
shall hereafter fix for the beginning of the physical examination of 
all or any number or proportion of registrants, and after a registrant 
has been placed in Class I by a District Board (regardless of any 
appeal to the President in his case), or, if no appeal or claim is 


56 


made before the District Board, then after the lapsing of time for 
appeal from the placing of the registrant in Class I by the Local 
Board, the Local Board shall mail to the last known address of any 
registrant placed in Class I a notice (Form 1009) to appear for 
physical examination at a time and place to be designated in said 
notice (which time shall be five days from the date of the mailing 
of the notice), and shall enter the date of mailing of said notice in 
column 19 of the Classification List. 

Upon appearance of the registrant he shall be examined as pro¬ 
vided in Part VIII hereof, and the date of his examination shall be 
entered in column 20 of the Classification List. The examining physi¬ 
cian shall immediately enter his report and recommendation in 
triplicate on the report of physical examination (Form 1010), shall 
then and there inform the registrant of his conclusion as to whether 
the registrant is qualified or disqualified for general military service 
or qualified for limited militar}' service in some specified capacity, 
and shall forthwith submit his report to the Local Board. 

If the registrant is not satisfied with such conclusion, he shall then 
and there record, iti the place provided on Form 1010, a request to 
be sent before a Medical Advisory Board. Failure to make this 
request on the day the registrant is examined and informed of the 
examining physician’s conclusion shall foreclose the right of the 
registrant to appeal the finding of the Local Board on the physical 
qualification of the registrant. 

The same procedure as to physical examination provided in these 
regulations for registrants in Class I shall also apply to all regis¬ 
trants who have been placed in a class more deferred than Class I, 
so soon as the immediately preceding or earlier class has been ex¬ 
hausted by calls into the military service and not before, except as 
provided in sections 128, 149, and 150. 

No affidavits or other documentary evidence concerning the present 
or past physical condition of a registrant shall be filed with a Local 
Board or Medical Advisory Board except such sworn statement of 
the registrant himself or of some other person as may be required by 

the Local Board or by the Medical Advisory Board. 

# 

Note 1.—Whether the examining physician of the Local Board is in doubt or 
not as to the physical qualification of a registrant for military service he shall 
nevertheless definitely report the registrant either as qualified or disqualified, 
and if he is in doubt as to such qualification or disqualification he may request 
to have the registrant sent before a Medical Advisory Board as prescribed in 
section 123. 

Note 2.—In accordance with section 122 the Provost Marshal General hereby 
directs that immediately upon the mailing of notice of final classification to 
registrants who have been finally classified in Class I Local Boards shall send 


57 


to all such registrants notices to appear for physical examination, and shall 
proceed to physical examination without delay and continue to examine all 
registrants so soon as they have finally been placed in Class I until all regis¬ 
trants in Class I have been physically examined or until the Provost Marshal 
General shall issue orders to the contrary. (Tel. A. 639.) 

Note 3. —Registrants in Classes II, III, and IV will not be physically examined 
except upon general order issued by the Provost Marshal General, or when 
special call is made for the induction into military service of registrants in such 
classes. 

• 

Section 123, S. S. R. Sending doubtful cases to a Medical Advisory Board. 

If the examining physician is in doubt as to whether the registrant 
is to be held for military service, or if the examining physician finds 
the registrant to be qualified for military service and either the 
Government appeal agent, the registrant, or two members of the 
Local Board, are dissatisfied with such finding, such examining 
physician, Government appeal agent, members of the Local Board, 
or registrant may apply to the Local Board to have the registrant 
sent before the nearest Medical Advisory Board (provided in sec¬ 
tions 29 and 41 hereof) for an exhaustive reexamination. Such ap¬ 
plication shall be made by entering it in the place provided in Form 
1010. Thereupon the Local Board shall, unless it decides by unani¬ 
mous vote that the case is one in which there is no room for reason¬ 
able doubt, immediately send the registrant before such Medical 
Advisory Board, forwarding to the Medical Advisory Board the 
examining physician’s report (Form 1010) in triplicate and, where 
necessary, and when the registrant is not sent at his own request, 
furnishing the registrant with transportation and meal and lodging 
tickets for the time during which he will be before such Medical 
Advisory Board, in no case to exceed three days. 

If the registrant is held to be physically disqualified by the ex¬ 
amining physician, the Local Board shall, unless it decides by unani¬ 
mous vote that the disqualification is so obvious as to leave no room 
for reasonable doubt, send the registrant before such Medical Ad¬ 
visory Board in the manner just provided. 

Upon reference of a case from a Local Board as just provided, the 
Medical Advisory Board shall examine the registrant, record its 
findings in triplicate on Form 1010, and return all three copies of 
Form 1010 to the Local Board, with the conclusion and recommenda¬ 
tion in the case. 

Section 124, S. S. R. Finding 1 by Local Board as to physical qualification. 

Upon receipt of the report and recommendation of the Medical 
Advisory Board as provided in section 123, or, if the case has not 
been sent to the Medical Advisory Board, then upon the receipt of 
the report of the examining physician, the Local Board shall make 
its decision as to the physical qualification of the registrant. If the 
registrant is found physically disqualified for general military serv- 


58 


ice, the Local Board shall cancel the cross mark (X) or cipher (0) 
which has already been entered in a classification column by draw¬ 
ing a red-ink line through such cross mark or cipher and shall enter 
the classification of the registrant in Class V, column 12. If the 
registrant is found, in accordance with section 122 hereof, to be 
physically disqualified for general military service, but qualified to 
perform special and limited military service, his place in the classifi¬ 
cation column shall not be changed, but the Local Board shall, with 
red ink, inscribe a bold circle around the cross mark (X) or cipher 
(0) in such classification column. (See sec. 188, Part VIII.) 

While men found disqualified for general military service but qualified 
for special and limited military service are not placed in Class V, they 
are subject to induction into military service only when a special or spe¬ 
cific call for men disqualified for general military service and qualified for 
special military service only is made. 

If the finding of the Local Board is not in accord with the recom¬ 
mendation of the Medical Advisory Board, the Local Board shall 
make a special report to the District Board of its reason for rejecting 
the recommendation of the Medical Advisory Board. 

The Local Board shall, on the day of its decision as to the physical 
qualification of any registrant, mail to such registrant a notice (Form 
1011) of the result of such decision and shall enter the date of such 
mailing in column 21 of the Classification List (Form 1000). 

Note. —See section 128| S. S. R. (below) concerning “deferred remediable 
group.” 

Section 125, S. 8. R. Appeal from finding’ of Local Hoard as to physical 
qualifications. 

Within five days after the date of the notice prescribed in section 
124 any registrant may make a claim of appeal to the District Board 
from the finding of the Local Board as to his physical qualification 
for military service. Claim of appeal shall be made by entering the 
claim in the place provided for that purpose on all three copies of the 
physical examination report (Form 1010). No registrant may make 
a claim of appeal unless, upon being notified of the examining 
physician’s finding as to his physical qualification, as prescribed in 
section 122, and before final decision by the Local Board, such regis¬ 
trant shall have entered an application to be sent before a Medical 
Advisory Board, as provided in section 122. The Government appeal 
agent may make a claim of appeal on behalf of the United States at 
any time, but ordinarily he shall not do so when the decision of the 
Local Board follows the recommendation of the Medical Advisory 
Board. He shall always do so when such is not the case. 

Immediately upon filing of an appeal from the decision of the 
Local Board as to physical qualification, the Local Board shall trans¬ 
mit to the District Board all three copies of the record of physical 


59 


examination (Form 1010) in the case, together with any additional 
evidence as to physical qualification which may have been submitted 
to the Local Board, and shall enter the date of forwarding such 
record in column 22 of the Classification List and in the place pro¬ 
vided on the Cover Sheet. 

Note. —The entry of the registrant on the Questionnaire of a claim of 
physical disqualification is not to be construed as a claim from which an appeal 
lies to the District Board from the refusal of the Local Board to classify the 
registrant in Class V (g). x\ppeals from classification on physical grounds may 
he made as provided in sections 122 to 128, inclusive, and not otherwise. (See 
Tel. A 2142.) 

Section 126, S. S. R. Action by District Board upon appeal as to physical 
qualification. 

In considering a case appealed on the ground of physical qualifica¬ 
tion, the District Board shall neither conduct any new physical ex¬ 
amination nor shall it receive or consider any evidence which was not 
considered by the Local Board, but shall, upon consideration of the 
record sent to it as prescribed in section 125, either affirm, modify, or 
reverse the decision of the Local Board and promptly enter its find¬ 
ing on all three copies of Form 1010, and immediately return the same 
to the Local Board. 

Note.— Attention of District Boards is invited to the fact that registrants 
appealing the result of their physical examination have already been twice 
examined, one of which examinations was the most thorough that could reason¬ 
ably be provided in the community, and that before induction into military 
service they will again be exhaustively examined at a mobilization camp. 

Section 127, S. S. R. Procedure of Local Board on return of physical 
examination record from District Board. 

If the action of the District Board on appeal as to physical qualifi¬ 
cation changes or affects the classification of the registrant, the Local 
Board shall make the necessary changes in the Classification List. 
Whether the action of the District Board changes or affects the Classi¬ 
fication by the Local Board or not, the Local Board shall mail to the 
registrant a notice (Form 1011) of the result of the decision by the 
District Board, and shall enter the date of mailing of such notice in 
column 23 of the Classification List. 

Section 128, S. S. R. Physical examination of persons not in Class I. 

Local Boards may, upon the application of registrants in Classes II, 
III, or IV, examine such registrants physically, pass upon their 
physical qualifications and, if they are found to be permanently dis¬ 
qualified, to classify them in Class V. This is not a right of the 
registrant, but it is a privilege that may be accorded by the Local 
Board where the according of the privilege will not interfere with 
the prompt and orderly execution of the Selective Service Law. 


GO 


Section 1281, S. S. R. Grouping of registrants. 

The Regulations governing physical examinations by Local Boards 
prescribe a standard of unconditional acceptance and a standard of 
unconditional rejection. Certain cases found, upon physical exami¬ 
nation by a Local Board, falling between these two standards are 
to be referred by the Local Board to the Medical Advisory Board 
in the same manner as other cases that are required by these regula¬ 
tions so to be referred. Cases so referred as falling between these 
two standards, and cases referred to Medical Advisory Boards under 
other provisions of these regulations, shall be examined by the Medi¬ 
cal Advisory Boards, who shall advise the Local Boards to: 

A. Accept the registrant as physically qualified for general military 
service; or 

B. Accept the registrant as physically qualified for general military 

service when cured of- (naming remediable defect for which 

acceptance is authorized) ; or 

C. Accept the registrant as physically qualified for special or lim¬ 
ited military service in a named occupation or capacity; or 

D. Reject the registrant; 

and shall record their finding in the proper spaces provided on Form 

1010 . 

Medical Advisory Boards shall find a registrant physically qualified 
for general military service (Rule A above) only when he falls within 
the standard of unconditional acceptance as prescribed in sections 182 
to 188, inclusive, as further explained and amplified by the Standards 
of Physical Examination, including cases of slight remediable defects 
not included under foregoing Rule B. 

Medical Advisory Boards shall find a registrant physically quali¬ 
fied for general military service when cured of a remediable defect 
(Rule B above) only in those cases when such acceptance is specifically 
authorized; namely, when a registrant is found to fall within the 
“ Deferred remediable group.” 

When a Medical Advisory Board determines that a registrant 
should be accepted for general military service when cured of such 
remediable defects (Rule B above) the Medical Advisory Board shall 
insert in ink in the space provided on page 2 of Form 1010, under 
the general heading “ Physical examination by Medical Advisory Board,” 
and following the words “ PhysicallyApialified for general military 

service,” the words “when cured of_,” followed by the name 

or diagnosis of the remediable defect, which name or diagnosis is to 
be followed by a circle in black ink. Upon return to the Local Board 
of the record (Form 1010) in such a case, and if the finding of the 
Medical Advisory Board is confirmed by the Local Board, the regis¬ 
trant’s place in the classification column shall not be changed, but 
the Local Board shall, with black ink, inscribe a bold circle around the 




61 


cross mark (X) or cipher (0) in such classification column; and 
such registrant shall be inducted into military service, after his 
order number is reached, and only at such time as may be desig¬ 
nated by the Surgeon General of the Army, on order issued by the 
Provost Marshal General’s office, and shall be sent to cantonment base 
hospital, reconstruction camp, or civic general hospital as may be 
determined by the Surgeon General. 

Registrants shall be found by Medical Advisory Boards as “ physi¬ 
cally qualified for special or limited military service ” (Rule C above) 
only in those cases described in the Standards of Physical Ex¬ 
amination, and in such cases the Medical Advisory Boards shall 
designate the occupation or class of service for which such persons 
are physically qualified in the space provided on page 2 under 
the general heading “ Physical examination by Medical Advisory Board ” 
(Form 1010 P. M. G. O.), after the words “ physically qualified for 

special or limited military service as” -. If such finding is 

confirmed by the Local Board the same shall be indicated on the 
Classification List as provided by section 124. 

Registrants shall be found by Medical Advisory Boards as physi¬ 
cally deficient and not physically qualified for military service (Rule 
D above) only when they fall within the standards of unconditional 
rejections as prescribed in sections 182 to 188, inclusive, as further 
explained and amplified by the Standards of Physical Examination. 

When a Medical Advisory Board delays the examination of a 
registrant on account of temporary defects it must return to the 
proper Local Board Form 1010 with a statement attached thereto 
(but not written thereon) stating the reason for delay, and fixing 
a definite period of time within which the registrant shall be sent 
back to it. At the end of said period, or earlier, if it believes the tem¬ 
porary defect is removed, the Local Board shall send the registrant 
back to the Medical Advisory Board, unless the Local Board believes 
that the examination should be further delayed, in which event it 
shall report the facts upon which its belief is- based to the Medical 
Advisory Board and request its instructions. 

Local Boards may accept a registrant as physically qualified for 
special or limited military service in a named occupation or capacity 
without reference to the Medical Advisory Board. 

Note.—T he foregoing regulations, quoted from the Selective Service Regu¬ 
lations, clearly indicate the four groups into which registrants should be 
grouped by Local, District, and Medical Advisory Boards as a result of the 
physical examinations in accordance with the Manual of Standards of Physical 
Examination. 

In other words, Group A shall contain registrants found to be qualified for 
general military service within the standards of unconditional acceptance, in¬ 
cluding registrants with slight remediable defects; for example, a registrant 
who, under examination of the nose, is found to have “ Benign growth of any 



62 


kind, nasal polypi, hypertrophy of the mucous membrane, benign superficial 
ulcerations, deviation of the septum.” 

Registrants with such slight remediable defects shall be held physically quali¬ 
fied for general military service, the defects to be remedied after the registrant 
enters the cantonment (if not remedied pending orders). 

All registrants coming within the foregoing definition and as specifically indi¬ 
cated in the instructions in the Manual are to be included in Group A and 
reported as physically qualified for general military service in the place indi¬ 
cated on Form 1010. 

Group R shall contain registrants who are found to be physically qualified 
for general military service when cured of some remediable defect, which is 
of such a character that it must be remedied or cured before the registrant 
can be ordered into service. 

Group C shall contain registrants who are found not to be within the standard 
of unconditional acceptance on account of defects which are not remediable, nor 
sufficiently incapacitating to bring them within the condition of unconditional 
rejection. This is the group of registrants who may be found to be qualified foy 
special or limited military service. 

Group D shall contain all registrants coming within the standards of uncon¬ 
ditional rejection and includes all cases not included in Groups A, B, and C. 
Such registrants must be reported on Form 1010 as “ Physically deficient and 

not physically qualified for military service by reason of -” (the reason 

for the disqualification to be stated in the blank provided). 

In arriving at their decisions concerning the physical qualifications of regis¬ 
trants, Medical Advisory Boards must be governed, as to the grouping of 
registrants, by the specific instructions contained in this Manual. 

IMPORTANT NOTE.—Whenever it shall appear to a Local Board or 
to a Medical Advisory Board that a registrant is suffering from self- 
inflicted or purposely caused physical defects which, under the Standards 
of Fhysical Examinations would render him disqualified for military 
service of any kind, a full statement of the facts and of the condition of 
the registrant and of the Board’s recommendation shall be prepared and 
attached to Form 1010, and one copy of Form 1010, with such statement 
attached, shall immediately be sent by the Local Board to the Adjutant 
of the State to be transmitted to the Provost Marshal General in order 
that the case may be submitted to the Surgeon General and The Adjutant 
General of the Army for a waiver of the physical defects, if recommended, 
so that the registrant may be compelled to render military service. 

Section 137, S. S. R. Delinquents reporting to Adjutant General of the 
State within five days after induction into military service. 

If the delinquent reports to the Adjutant General of the State 
within five days after the date set for induction into military service, 
such Adjutant General shall order him to report to the nearest 
Medical Advisory Board or to any examining physician of a Local 
Board for physical examination, and shall defer reporting him to 
The Adjutant General of the Army until the result of such examina¬ 
tion is known. The Medical Advisory Board or such examining 
physican shall forthwith examine him and report the result (Form 
1010) to the Adjutant General of the State. If the delinquent is 



63 


found qualified for military service, lie shall be ordered by the 
Adjutant General (Form 1019) to report forthwith to his Local 
Board for military duty and immediate transportation to a mobiliza¬ 
tion camp. Where it is impracticable to order the delinquent to 
report to his own Local Board, he may be ordered to report to 
another Local Board, whereupon the Adjutant General shall notify 
the delinquent’s Local Board of the order and the case shall there¬ 
after be treated as prescribed in section 148. 

No report is necessary to The Adjutant General of the Army in this 
case, but the Adjutant General of the State shall make a full report 
of all circumstances of the case in a letter addressed to the com¬ 
manding officer of the mobilization camp, but sent to the delinquent’s 
Local Board, together with the order of induction into military 
Service (Form 1014), the order to report to such Local Board for 
military duty, and three copies of the report of the Medical Advisory 
Board or examining physician (Form 1010). The Local Board 
shall forthwith send the man to the mobilization camp in the usual 
manner, inclosing with Form 1029 the special report of the Adjutant 
General of the State, the order of induction into military service 
(Form 1014), the order to report to the Local Board for military 
duty (Form 1019), the report of the Medical Advisory Board in 
duplicate, and a copy of the delinquent’s registration card in 
duplicate. 

If the deliquent is found to be disqualified for military service, 
the Adjutant General of the State shall report the case to the com¬ 
manding officer of the mobilization camp direct, by letter, inclosing 
copies of the order of induction into military service (Form 1014) 
and the report of the Medical Advisory Board or examining physi¬ 
cian. Such commanding officer shall, in his discretion, forthwith 
order the delinquent discharged from military service or shall order 
him before a court-martial, as the interests of the service may require. 
Section 141, S. S. R. Transfer of physical examination. 

A registrant Avho is so far distant from his home when called to 
report to his Local Board for physical examination, or when his 
physical examination is imminent, as to make it a hardship for him 
to report may, at his own expense, request of his Local Board, by 
mail or telegram, permission to be examined by the Local Board to 
which he is nearest (naming it). Upon receipt of such a request, the 
Local Board of origin shall mail to the registrant an order to report 
to such Local Board of transfer for physical examination (using 
Form 1022, but making the necessary correction thereon), and to the 
Local Board of transfer a request that he be so examined (using 
Form 1022 A). Thereupon the Local Board of transfer shall physi¬ 
cally examine the registrant, and thereafter the procedure in regard 
to the registrant whose physical examination has so been transferred 


64 


shall be the same as if he were originally a registrant of the Local 
Board of transfer. After all such procedure is completed, the Local 
Board of transfer shall return to the Local Board of origin all three 
copies of Form 1010 with a report of its finding and the report, if 
any, of the Medical Advisory Board, and the report, if any, of the 
finding of the District Board of the jurisdiction of transfer. 

Section 142, S. S. R. Physical examination of persons residing abroad. 

Either before or upon receiving a notice to report for physical 
examination a registrant residing in a foreign country in a place too 
far for exacting a journey to the United States may, at his own ex¬ 
pense, apply by mail, cable, or telegram to be physically examined 
by a near-by physician to be appointed by the American consul to 
make the examination. Thereupon the Local Board should forward 
to the applicant four copies of Form 1010 and a copy of these Begu- 
lations. Upon receipt thereof the applicant shall present himself to 
the consul. The consul shall appoint a competent physician to make 
the examination and shall indorse the appointment upon the face of 
three copies of Form 1010. Thereupon, the examination shall be 
made, and the consul shall return the report of physical examination, 
in triplicate, to the Local Board. Upon receipt of such report, the 
Local Board may proceed to a decision as to the physical qualifica¬ 
tion of the registrant. 

The foregoing rule does not apply to the places adjacent to the 
United States reasonably accessible. In such cases the registrant 
should return to his Local Board, or apply for a transfer of physical 
examination to a Local Board in the United States under the pro¬ 
visions of section 141. 

Section 143, S. S. R. Physical examination of mariners actually employed 

on the Great Lakes. 

A mariner employed on the Great Lakes may apply to the Local 
Board which has called him to have his physical examination made 
by any board hereinafter named, and upon such application his 
Local Board may issue an order designating any Local Board hav¬ 
ing jurisdiction in any of the following cities or towns or any division 
thereof to make such physical examination: Buffalo, N. Y.; Erie, 
Pa.; Conneaut, Ashtabula, Fairport, Painesville, Cleveland, Lorain, 
Huron, Toledo, and Sandusky, Ohio; Detroit, Marquette, and 
Escanaba, Mich.; Ashland, Superior, Sheboygan, and Milwaukee, 
Wis.; Duluth and Two Harbors, Minn.; Chicago, Ill.; Gary, Ind. 

The order should state that any Local Board having jurisdiction 
in any of the above cities or any division thereof may make the ex¬ 
amination instead of stating that any particular board may make the 
examination. 


65 


Section 177, S. S. li. Disposition of men rejected or discharged from 
military service at a military camp or station. 

When any selected man is rejected at a military camp or station, 
the commanding officer thereof will promptly notify his Local Board 
of the fact, specific cause, and date of rejection, using Form 1029 A, 
and the Provost Marshal General using Form 1029 B. When any 
selected man is, subsequent to acceptance, discharged at a military 
camp or station, the commanding officer thereof shall similarly notify 
the Local Board (Form 1029 C) and the Provost Marshal General 
(Form 1029 D). 

If the rejection or discharge is on account of the fact that the 
registrant is an alien, or an alien enemy, or upon the request of the 
accredited diplomatic representative of the* country of which the 
registrant is a citizen, or that he is physically disqualified for gen¬ 
eral military service, the Local Board shall place the registrant forth¬ 
with in Class V. If the discharge or rejection is on account of de¬ 
pendency or any other cause for deferred classification prescribed by 
these regulations, the Local Board shall proceed to reclassify the 
registrant in accordance with his status, as determined by the action 
of the military authorities in discharging him. 

Note 1.—Section 177 is necessarily modified by tlie new grouping, also by new 
standards of physical examination, and should be applied in connection with 
Sections 116, 117, 118, and 120 of the Selective Service Regulations. 

Note 2.—Where the Form 1029 C shows that the reason for the discharge of the 
registrant was physical disqualifications, which, under the new physical exami¬ 
nation requirements, unfit him for any military service, the Local Board, 
under section 177, shall place the registrant forthwith in Class V. 

Note 3.—Where Form 1029 C shows grounds for discharge to be physical dis¬ 
qualification for general military service, but defects which might place him in 
the deferred remediable group or leave him fit for special or limited military 
service, the Local Board should proceed to reclassify the registrant in accord¬ 
ance therewith, and if he is placed in Class I, the board should proceed to re¬ 
examine the registrant under the new standards of physical examination and to 
classify such registrant in accordance with such physical examination. 

Note. 4.—Local Boards are authorized under sections 116, 117, 118, and 120, 
on their own motion, to reclassify registrants. Local Boards should keep advised 
with respect to any change in the physical conditions of discharged registrants 
which removes the physical disability, and have full authority if a change of 
status of this nature occurs, to reclassify the registrant, placing him in Class I, 
and order that he be reexamined. 

Section 182, S. S. R. Preliminary statement. 

In view of the contemplation of a further investigation and classi¬ 
fication of registrants physically qualified for special and limited 
military service who have not the physical qualifications for general 
military service, and in view of the decision to accept some regis¬ 
trants for general military service with remediable defects, who are 
otherwise physically and mentally qualified for military service, the 
following new regulations for the physical examination of regis¬ 
trants by the physician on the Local Board becomes necessary: 


66 


Local Boards can accept registrants for general military service 
only when they come within the standards for unconditional accept¬ 
ance with or without remediable defects. 

Local Boards can reject registrants for general military service 
only when the registrant comes within the standards of uncondi¬ 
tional rejection. 

Local Boards may accept registrants for special and limited mili¬ 
tary service; but must refer all doubtful and remediable cases to the 
Medical Advisory Board. 

Physicians on the Local Board are not required to make a com¬ 
plete examination of every registrant. The moment the physician 
on the Local Board finds a mental or a physical defect placing the 
registrant within the standards of unconditional rejection the physi¬ 
cian on the Local Board shall indicate this in Form 1010, section' 
282, page 156, after “ physically deficient and not physically qualified 
for military service by reason of ” in the space following write the 
disqualifying defect. 

In all other cases the Local Board shall make a complete exami¬ 
nation of registrants; and, when the physician on the Local Board 
finds a defect which does not come within the standards of uncondi¬ 
tional rejection but does take the registrant out of the class within 
the standards of unconditional acceptance, he shall proceed to make 
a complete examination and will then refer the registrant to the 
Medical Advisory Board, reporting the result of the complete exami¬ 
nation, including a report of the defect or defects, on Form 1010. 
(Sec. 282, S. S. R.) 

Registrants can not be declared physically qualified for general 
military service (see Form 1010, sec. 282, S. S. R.) until the complete 
examination has been made by the physician on the Local Board, 
with the finding that the candidate comes in every instance within 
the standards of unconditional acceptance with or without remedi¬ 
able defect. Then, it is so noted and recorded on Form 1010 (sec. 
282, S. S. R.), and if there is a remediable defect, this is also re¬ 
corded after “ physically qualified for general military service.” 

Section 186, S. S. It. Degree of deficiency for disqualification. 

In these regulations the standards for unconditional rejection which 
places the registrant in the class physically deficient and not physi¬ 
cally qualified for military service are clearly defined. When the 
Local Board is in any doubt, the registrant should be referred to the 
Medical Advisory Board. The attention of Local Boards and ex¬ 
amining physicians is called to paragraph 3 of section 123, page 64, 
after the side heading, “ Where held disqualified,” which is as follows: 

If the registrant is held to be physically disqualified by the examining 
physician, the Local Board shall, unless it decides by unanimous vote that 


67 


the disqualification is so obvious as to leave no room for reasonable 
doubt, send the registrant before such Medical Advisory Board in the 
manner just provided. 

This shows that there must be a unanimous vote of the Local Board 
to disqualify the registrant, and the disqualification must be so 
obvious as to leave no room for reasonable doubt. 

The object of this ruling has already been given. 

Section 187, S. S. It. Temporary defects. 

Registrants confined to their homes or hospitals, or who present 
themselves with some temporary defect, the result of an acute disease, 
injury, or operation, or who are waiting for operation, should be 
granted a reasonable delay for completing the physical examination. 

All of these cases should be thoroughly investigated by the physi¬ 
cian on the Local Board. 

Registrants with contagious, communicable, reportable diseases 
should not be ordered before the Local Board for examination until 
they are discharged by the boards of health. 

Registrants recovering from diphtheria should not be ordered to the 
cantonments until two negative cultures have been obtained from the 
throat. In localities where there is no provision for this bacteriologi¬ 
cal work, consult the Medical Advisory Board. 

Section 188, S. S. R. Special and limited military service. 

In view of the importance of a thorough investigation and classi¬ 
fication of registrants belonging to this group, Local Boards are re¬ 
quired to refer all of such registrants to the Medical Advisory Board. 

The physician on the Local Board is urged to consult with the Medical 
Advisory Board about this group and familiarize himself with the spe¬ 
cific regulations and information soon to be given to the Medical Advisory 
Board concerning special and limited military service. 

Section 196, S. S. R. Examining physicians—Rate of pay. 

It is the duty of any physician who is a member of a Local Board 
to make physical examinations, and additional examining physicians 
should be compensated only where acceptable gratuitous service can 
not be obtained, and where, in accordance with section 42, the com¬ 
pensation of an examining physician in addition to the physician 
member of the Board is authorized. 

Physician members of Local Boards and examining physicians not 
members of Local Boards may receive compensation at the rate of $1 
per hour for each hour that they are actually present at the office 
of the Board and fully engaged in the duties of making physical 
examinations, but not in any case to exceed $7.50 for any single day 
or $150 for any single month. 

Section 197, S. S. R. Allowance of clerical assistance to be regarded as 
a maximum. 

The allowances of clerical assistance and compensation thereof as 
prescribed in section 43 should be regarded as maximum limits, and 


68 


every effort should be made by all concerned in the execution of the 
selective-service law to keep the expenses of the Government in the 
emergency down to the absolute minimum consistent with efficient 
service. Uncompensated and volunteer service should be encouraged 
and accepted. The great task of segregating and classifying regis¬ 
trants may be made very much easier for members of Local and Dis¬ 
trict Boards if clerical assistance is utilized to the fullest extent in 
preparing and segregating Questionnaires for the consideration of 
the Board. Much of this preliminary work can be done by volunteer 
clerical assistance in the evening, and every encouragement should be 
extended to patriotic citizens, women as well as men, to assist in this 
work. 

Section 198, S. S. R. Authority for civilian clerical assistants. 

The form of authorization required to be made by the governor of 
the State before a claim for salary of a civilian clerk for a Local or 
District or Medical Advisory Board, or for State headquarters, may 
be paid will be found in section 30G but no printed forms will be 
furnished. The governors shall not authorize any allowances or 
compensation in excess of the allowances and compensation fixed in 
section 43, nor in excess of that authorized by the law of the State, 
or that usually paid for similar services in the State. The number of 
the authorization should be entered in the place provided on every 
voucher on which a salary is paid. 

This authorization will be made in triplicate. One copy will be 
sent to the Board or office, one copy will be sent to the disbursing 
officer and agent for the State, and the original will be sent to the 
Provost Marshal General. The original only is required to be 
signed. 

Section 200, S. S. R. Travel. 

The Provost Marshal General and, when authorized by the Pro¬ 
vost Marshal General, the governors of the several States may direct 
any person to travel when such travel is necessary in the execution 
of the selective-service law. District Boards by resolution of the 
Board may direct members and employees of the Board to travel 
when such travel is necessary in the execution of the selective-service 
law. 

Travel must, when such means of transportation is available or less 
expensive, be performed by common carrier. 

When travel is performed in compliance with orders issued as au¬ 
thorized in this section, cost of transportation and Pullman accom¬ 
modations over the shortest usually traveled route will be allowed 
and payment may be made of a per diem of $4 in lieu of subsistence 
while traveling, and while the person ordered to travel is required 
by duty to be absent on duty from the city in which such person 
resides. 


69 


When travel includes fractional parts of a day, the allowance for 
such fractional parts shall be $1 for each six hours or major frac¬ 
tional part thereof. 

Section 201, S. S. R. Travel orders. 

All orders for travel must state that the travel is necessary in the 
public service lyid in the execution of the selective-service law. 

The proper forms for travel orders will be found in sections 307 
and 308, but no printed forms will be furnished. 

Section 203, S. S. R. Certain officers and agents for whom no compensa¬ 
tion is provided. 

The service of members of Medical Advisory Boards, prescribed in 
section 29, of members of Legal Advisory Boards prescribed in sec¬ 
tion 30, and of the Government appeal agents, prescribed in section 
47, shall be uncompensated. 

Section 204, S. S. R. Clerical assistance. 

Clerical assistance for the division of the Office of the Adjutant 
General or other administrative department at State headquarters 
and of District, Medical Advisory, and Local Boards shall be pro¬ 
cured and compensated as prescribed in section 43 of these regula¬ 
tions. 

Section 208, S. S. R. General expenses. 

The Provost Marshal General may authorize such lawful expendi¬ 
tures as he may deem necessary in the execution of the selective- 
service law. 

Section 215, S. S. R. Traveling expenses. 

Payment for traveling expenses will be made on War Department 
Form No. 350A, on which all blank spaces below the words “ The 
United States, To ” will be filled in down to the check notation. 'Each 
voucher shall be accompanied by a copy of the order of the Provost 
Marshal General or governor, or of the resolution of the District 
Board directing the travel, which resolution shall contain a state¬ 
ment that the travel directed is necessary in the public service and in 
the execution of the selective-service law; and a statement showing the 
following data: 

Means of transportation. 

Time of departure from permanent station. 

Time of arrival at temporary station. 

Time of departure from temporary station. 

Time of arrival at permanent station. 

If transportation other than common carrier is used, a certificate 
should be attached showing the fact that common carrier was not 
available or was more expensive, the distance traveled, and the fact 
that the amount claimed is that usually charged for similar services 
in the same locality. 


70 

RULES OF PROCEDURE FOR MEDICAL ADVISORY BOARDS. 

(1) Read carefully the Selective Service Regulations (S. S. R.), 

particularly the following sections: 25, 29, 43 (cl), 44, 40, 122 to 
128J, 137, 141, 182 to 188,‘ 197, 198, 200,' 201, 203, 204, 208, and 215. 
For ready reference all of these sections are reprinted in this ap¬ 
pendix. * 

(2) Medical Advisory Boards shall consist of three or more physi¬ 
cians. The number of Medical Advisory Boards and the member¬ 
ship of existing boards may be increased as necessity may indicate. 
(See sec. 29, S. S. R.) When a Medical Advisory Board believes 
that other boards should be created, or additional members added to 
existing boards, it should recommend the same to the governor. 

(3) Each board should select one member as chairman, one as 
vice chairman, and one as secretary. Additional vice chairmen may 
be selected. 

(4) Request to the governor for authority to employ clerical as¬ 
sistance and incur other expenses should be made only when abso¬ 
lutely necessary. Do not incur any expense until authorized by the 
governor. See sections 43 (d), 198, 204, and 208, S. S. R. Station¬ 
ery will be supplied by the Adjutant General. 

(5) No communications concerning the business of Medical Ad¬ 
visory Boards should be addressed to any department or official in 
Washington. Except for their communications with Local Boards, 
Medical Advisory Boards must address all official communications 
of every character, whether reports, recommendations, or requests 
for instructions or for interpretations to the Adjutant General of 
the State, who will either respond thereto or transmit the same to 
the proper authority. 

(6) Select a place as headquarters of the board where sessions may 
be held and physical examinations conducted. Select preferably a 
hospital or similar institution, where proper and careful examinations 
can be made. It ought not to be necessary to pay rental for such 
headquarters; but in the event that no free quarters can be obtained, 
application must be made through the Adjutant General of the State 
to the governor for authority to incur expense for rent. All physi¬ 
cal examinations and every part thereof should be conducted at head¬ 
quarters of the board, unless it should be necessary to resort to some- 
other place for the use of apparatus which is not otherwise available. 
See Preliminary Statement in this Manual. Sessions of the board 
should be held at stated hours and as frequently as necessity de¬ 
mands—daily, if necessary. 

(7) A majority of the board will constitute a quorum, except in 
cases of boards consisting of ten or more members, in which cases 
five members shall constitute a quorum. The board shall decide 


71 

all disputed questions by vote. The chairman need not vote except 
to break a tie. 

(8) It shall not be necessary for all or a majority of a board to be 
present at or participate in the examination of a registrant, but one 
or more members may be appointed as a subcommittee to make an 
examination and shall report to the board, who may pass on the report 
or may make or require a further examination. 

(9) If clerks are employed they are to be on duty at place of 
meeting daily, except Sundays and legal holidays, from 9 a. m. to 
5 p. m., and shall keep all records and conduct all correspondence 
under the direction of the board. 

(10) Any member of the board can sign Form 1010, reporting the 
result of physical examination by the Medical Advisory Board, desig¬ 
nating the signer as follows: “Chairman,” “vice chairman,” “secre¬ 
tary,” or “ member.” 

(11) Form 1010 when completed by the Medical Advisory Board 
will be returned in triplicate to the Local Board by which issued. 
If registrant has been examined at the request of the Adjutant Gen¬ 
eral, Form 1010 when completed by the Medical Advisory Board shall 
be returned in triplicate to- the Adjutant General. (See sec. 187, 
S/S. R.) 

(12) No permanent record is required to be kept by Medical Ad¬ 
visory Boards except a minute book and a list of registrants whose 
examination is temporarily delayed on account of temporary defects, 
as provided in this Manual. The Medical Advisory Board shall keep 
a minute book, using the following or substantially equivalent form, 
which is not supplied but must be written or typewritten, and kept 
in the possession of the board until order from the Provost Marshal 
General. 

Date of meeting_ Convened-M. Adjourned_M. 

Present (members of board). Arrived. Left. 


Business Transacted. 

Number of cases referred by the Local Board—-- 

Number finally acted on-_— - 

Number of cases referred by registrar or Appeal Agent 

Number finally acted on-,- 

Number of cases referred by The Adjutant General- 

Number finally acted on-1- 

Number of cases transferred from Local Boards- 

Number finally acted on- 


















72 


(13) Medical Advisory Boards must conduct all their proceedings 
in strict accordance with the Standards of Physical Examinations 
and the Selective Service Regulations, and at the headquarters of 
the board. 

(14) No physical examination, nor any part thereof, shall be con¬ 
ducted elsewhere (and especially not at the private office of a member 
of the board) except in case of absolute necessity and for the purpose 
of utilizing apparatus which is not available elsewhere. 

(15) Applications for authority to incur clerical and all other 
expenses (including such expenses as payment for materials in X-raj' 
work, etc.) must be made, before the expense is incurred, to the 
governor. (See secs. 43 (d), 198, 204, and 208, S. S. R.) 

(16) All inquiries, requests for interpretations, reports, and com¬ 
munications of every character (except those with Local Boards) 
must be addressed to the governor or State Adjutant General, either 
directly or through the medical aide to the governor. When neces¬ 
sary such communications will be forwarded through proper channels 
to the Surgeon General, or the office of the Provost Marshal General. 
(See sec. 25, S. S. R.) 

(17) Definite and explicit instructions with respect to headquar¬ 
ters, expenses, correspondence, and standards of examinations will 
be found in the text of the Standards of Physical Examination and 
the Selective Service Regulations. 

(18) In arriving at their decisions concerning the physical quali¬ 
fications of registrants, Medical Advisory Boards must be governed, 
as to the grouping of registrants, by the specific instructions con¬ 
tained in the Standards of Physical Examination. 

(19) Registrants referred to the Advisory Board who present 
themselves with some temporary defect, the result of a recent acute 
disease, injury, or operation, the Local Board should be advised to 
grant a reasonable time for recovery before the final examination by 
the Medical Advisory Board is made. 

(20) When Local or Advisory Boards can not command the facili¬ 
ties at the hospital headquarters for making throat cultures of regis¬ 
trants recovering from an attack of diphtheria as directed in section 
187 in the Regulations for Local Boards, the cultures from the 
throats of such registrants may be sent by mail to the laboratories of 
the United States Public Health Service. When possible municipal 
and State health laboratories should be utilized in the same way. 

(21) The Medical Advisory Board may employ section 187, 
S. S. R., “ Temporary Defects,” when they desire to grant the regis¬ 
trant a reasonable delay for completing the physical examination 
when it is difficult or impossible to come to a definite conclusion when 
the registrant first presents himself to the Medical Advisory Board. 


73 


(22) Medical Advisory Boards in those districts in which the 
registrants must be sent to them from a distance should suggest to 
their Local Boards to hold registrants under section 187, S. S. R., 
for a reasonable time and not to send them to the Medical Advisory 
Board until the examination can be completed within at most three 
days. If possible, the examination, should always be completed 
within one day, / 




ao 

bj- a V 









INDEX 


[References are to sections. See also index to appendix on page 75.] 

Sections. 

Abdomen, concerning. 88-97 

Alcoholism, chronic. 112,119 

Anemia, progressive, pernicious, secondary, splenic. 167,168 

Anesthetic, use of, in diagnosis. 16 

Apices, lungs. 139 

Blood vessels, concerning.152-165 

Brain, organic diseases of.... . 122-130 

Cancer, concerning. 168 

Chest, standard measurements. 81-87 

Chest wall, concerning.131-151 

Chronic alcoholism. 112,119 

Clinical forms of insanity.... 120,121 

Debility, concerning. 167 

Dental requirements. 47-52 

District Boards, jurisdiction and powers of ( see Appendix). 9 

Drug, addiction to, concerning. 110 

Ears, concerning. 34-40 

Epilepsy, concerning. 112,116 

Esophagus, concerning. 41-46 

Examinations, order and method of. 15-17 

Extremities, concerning. 75-80 

Eyes, concerning. 18-33 

Fauces, concerning. 41-46 

Feet, defects of. 75-80 

Fingers, concerning. 75-78 

Genito-urinary organs, concerning. 103-108 

Groups indicating physical qualifications (sec. 128£, S. S. It.). 4 

Hands, concerning. 75-78 

Head, concerning. 58-60 

Hearing, concerning. 34 7 40 

Heart, concerning. 152-165 

Height, standard measures. 81-87 

Hemophilia. 168 

Idiocy, concerning. 112,117 

Illness and injuries confining to home, etc., concerning. 169 

Imbecility, concerning. 112,118 

Injuries, confining to home, etc., concerning. 19 

Insanity: 

Concerning. 112,115 

Clinical forms of. 120,121 

Larynx, concerning. 41-46 

Local Boards, jurisdiction powers ( see Appendix). 4-14 

Lumbo-sacral joints, concerning. 67-71 

Lungs and chest wall, concerning. 131-151 

Malaria, acute or chronic, concerning. 166 

Malingering: 

Notes on. 174-186 

Hearing, lest to detect. 39, 40 

Vision, test to detect. 26-33 


( 74 ) 

















































' 



4 i) 


Measurements, directions and standards. 

Medical Advisory Boards, concerning (see Appendix). 

Medical Aide, concerning (see Appendix).. 

Mental diseases, cone ning. 

Metallic poisoning, in lediable.. 

Military authorities, powers of.. 

Mouth,• concerning... 

Murmurs of heart, concerning. 

Neck, concerning. 

Nerves, peripheral, organic diseases of. 

Nervous diseases, concerning. 

Nose, concerning. 

Order of examination.. 

Organic diseases, brain, spinal cord, peripheral nerves 

Pellagra, concerning. 

Peripheral nerves, organic diseases of. 

* a s. e> C - # 

Pharynx, concerning. 

Pleurisy, concern ing. 

Rules, preliminary and general... 

Saero iliac and lumbo-saeral joints. 

Scapulae, concerning. 

Skin, concerning. 

Spinal cord, organic diseases of. 

Spine, concerning. 

Standards of physical examination: 

Purpose and use of. 

To whom applicable. 

Temporary defects, concerning. 

Teeth, definitions, etc. 

Thumbs, concerning. 

Trachea, concerning... 

Tuberculosis: 


Diagnosis of, in general. 

X-ray, uses of.... 

Venereal diseases, concerning- 

Weight, measurements, standards 
X-ray plates, use of. 


Sections. 

. 81-87 

. G—14 

. 10 

. 109-130 

. 168 

. 12 

. 41-46 

. 152-165 

. 98-102 

. 122-130 

. 109-130 

. 41-46 

. 15-17 

. 122-130 

. 16S 

. 122-130 

. 41-46 

... 131-138 

. 1-14 

..,. 67-71 

. 72-74 

. 53-57 

. 122-130 

. 61-71 

. 1 

. 2-3 

. 170-173 

. 47-52 

... 75-78 

. 41-46 

. 131-151 

. 150-151 

. 103-10S 

. 81-87 . 

46, 66, 71, 93,107,150,151 


INDEX TO APPENDIX. 


[References are to pages.] 


rage. 


Clerical assistance, appointment, expenses, etc. (secs. 43, 197, 198, 204, 


S. S. R.)_-_—'54, G7, 68, 69 

Correspondence rules (sec. 25, S. S. R.)--- 52 

District Boards: 

Appeals to (sec. 125, S. S. R.)- 58 

Powers and duties (sec. 126, S. S. R.)- 59 

Expenses, general (sec. 208, S. S. II.) —- 69 


Grouping of registrants as to physical qualifications (sec. 1284, S. S. R.)_ 60 














































0 011 520 163 3 


Tage. 

LIBRARY OF CONGRESS 


Local Boards: 

Appeals from findings (sec. 125, S. S. R)-. 

Organization awl rules (sec. 38, S. S. R.) — 

Powers and duties (secs. 122-1281, S. S. R.) 

Procedure as to returned records (sec. 127, i 
Registrants grouped by (secs. 1281, 182, S. 8 
Medical Advisory Boards: 

Appointment, etc. ,(sec. 20, S. S. 

Clerical assistance for (secs. 43, 107, 198, 204, s. s. it.;-on, o<,oo, o 

Dentists on (secs. 42, 44, S. S. R., notes)-— 54,55 

Duties and personnel of (secs. 44, 123, S. S. R.)- 54,55,57 

Rules of procedure for_70, 73 

State districts under (sec. 20, S. S. R.)- 52 

Medical Aide to Governor: • 

Appointment (sec. 20, S. S. R.)_ 52 

Duties of (sec. 20, S. S. R.)_52, 53 

Physical examination: 

Appeals from finding of Local Boards (sec. 125, S. S. R.)_ 00 

Delinquents, when made (sec. 137, S. S. R.)_ 02 

Disqualification, degree of deficiency for (sec. 180, S. S. R.)_ 00 

Doubtful cases sent to Medical Advisory Board (sec. 123, S. S. R.)_ 57 

Finding by Local Board (sec. 124, S. S. R.)_ 57 

Grouping of registrants after (sec. 128i, S. S. R.)_ 00 

Mariners employed on Great Lakes (sec. 143, S. S. R.)_ 04 

Persons not in class 1 (sec. 128, S. S. R.)_ 59 

Persons residing abroad (sec. 142, S. S. R.)_ 04 

Powers and duties of District Boards (sec. 120, S. S. R.)_ 59 

Powers and duties of Local Boards (secs. 122-1284, S. S. It.)_55-02 

Powers and duties of Medical Advisory Boards (secs. 44, 123, 

S. S. R.)_ 54,55,57 

Procedure governing (secs. 122-1284, S. S. It .) _55-02 

Qualifications (secs. 128L 182, S. S. R.)_00,05 

Reexamination of rejected and discharged registrants, when (sec. 


177, S. S. R., note)____•____ 

Physical qualifications: 

Concerning (secs 1284, 1S2, S. S. R.)___ 

Degree of deficiency disqualifying (sec. 1SG, S. S. It.)_ 

Special and limited military service (sec. 1S8, S. S. R.)_ 

Temporary defects (sec. 187, S. S. It.)_ 

Physicians examining (sec. 38, S. S. R.)_i_ 

Additional, appointment and duties (sec. 42, S. S. It.)_ 

Duties generally (sec. 40, S. S. It.)_ 

Pay of, rate of (sec. 190, S. S. R.)_ 

Registrants, how grouped (secs. 128L 182, S. S. It.)_ 

Rejected or discharged men, disposition of (sec. 177, S. S. R.)_ 

Rules of Procedure for Medical Advisory Boards_ 

Special and limited military service (sec. 1SS, S. S. It.)_ 

Travel, concerning (sec. 200,vS. S. It.)_ 

Travel orders (sec. 201, S. S. It.)_ 

Traveling expenses (sec. 215, S. S. It.)___ 


04 

00, 05 
08 
07 
07 
53 


07 
00, 05 
05 
70-73 
07 
OS 
09 
09 


o 




























































